Comparison of Direct Oral Anticoagulants for Acute Hospital Mortality in Venous Thromboembolism
Comparison of Direct Oral Anticoagulants for Acute Hospital Mortality in Venous Thromboembolism
复制标题
直接口服抗凝药对静脉血栓栓塞急性院内死亡率的比较
DOI：
10.1007/s40256-021-00514-5
复制
发表时间：
2021
影响因子：
3
通讯作者：
Sata Masataka
中科院分区：
文献类型：
--
作者：
Okushi Yuichiro;Kusunose Kenya;Nakai Michikazu;Sumita Yoko;Ise Takayuki;Yamaguchi Koji;Yagi Shusuke;Fukuda Daiju;Yamada Hirotsugu;Soeki Takeshi;Wakatsuki Tetsuzo;Sata Masataka
静脉血栓栓塞症（VTE）的直接口服抗凝剂（DOAC）的选择由医生决定;然而，了解DOAC临床数据的差异有助于医生选择。我们旨在比较在临床实践中使用利伐沙班、依度沙班和阿哌沙班相关的死亡率。方法我们确定了38例，来自日本所有心脏和血管数据集登记研究（JROAD-DPC）诊断程序组合数据库的245例首次因VTE住院的患者。我们根据DOAC将患者分为三组（利伐沙班和依度沙班组、利伐沙班和阿哌沙班组、依度沙班和阿哌沙班组），并通过倾向评分（PS）匹配比较各组的住院死亡率和出血风险。（1.2%vs.2.1%;比值比[OR] 0.55，p = 0.012）和21天内（0.4%vs.1.0%; OR 0.41，p = 0.020）和28天内（0.7%vs.1.3%; OR 0.53，p = 0.042）的住院死亡率。在亚组分析中，仅在年龄小于80岁的患者、肺栓塞患者和无心力衰竭患者中观察到显著差异。其他组的住院死亡率和三组出血事件发生率无显著差异。结论在PS匹配分析中，住院死亡率存在差异，特别是在利伐沙班和阿哌沙班组。确定与每种DOAC相关的患者的临床特征以及预后将有助于确定VTE的治疗策略。
BackgroundThe choice of direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) is at the physician’s discretion; however, it is useful to know the differences in the clinical data of DOACs to help physicians choose.ObjectiveWe aimed to compare the mortality associated with the use of rivaroxaban, edoxaban, and apixaban in clinical practice.MethodsWe identified 38,245 patients with first hospitalization for VTE from the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). We classified patients into three groups by DOAC (rivaroxaban and edoxaban group, rivaroxaban and apixaban group, and edoxaban and apixaban group) and compared the in-hospital mortality and bleeding risk by propensity score (PS) matching in each group.ResultsAfter PS matching, patients with rivaroxaban use had significantly lower total in-hospital mortality (1.2% vs. 2.1%; odds ratio [OR] 0.55,p= 0.012) and in-hospital mortality within 21 days (0.4% vs. 1.0%; OR 0.41,p= 0.020) and 28 days (0.7% vs. 1.3%; OR 0.53,p= 0.042) than patients with apixaban use. In the subanalysis, significant differences were only observed in patients younger than 80 years of age, patients with pulmonary embolism, and patients without heart failure. There was no significant difference in in-hospital mortality in the other groups and in the rate of bleeding events among the three groups.ConclusionOn PS-matched analysis, there was a difference in in-hospital mortality, especially in the rivaroxaban and apixaban group. Identifying the clinical characteristics of patients associated with each DOAC, as well as prognosis, will be useful in determining treatment strategies for VTE.
影响因子：
5.4
作者：
Yamashita, Yugo;Morimoto, Takeshi;Kimura, Takeshi
通讯作者：
Kimura, Takeshi
影响因子：
7.1
作者：
Yamamoto T
通讯作者：
Yamamoto T
影响因子：
120.7
作者：
Castellucci, Lana A.;Cameron, Chris;Carrier, Marc
通讯作者：
Carrier, Marc