Temporal Trends in the Practice Pattern for Venous Thromboembolism in Japan: Insight From JROAD-DPC
Temporal Trends in the Practice Pattern for Venous Thromboembolism in Japan: Insight From JROAD-DPC
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DOI：
10.1161/jaha.119.014582
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发表时间：
2020-01-21
影响因子：
5.4
通讯作者：
Kimura, Takeshi
中科院分区：
文献类型：
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作者：
Yamashita, Yugo;Morimoto, Takeshi;Kimura, Takeshi
背景近年来，静脉血栓栓塞症（VTE）的直接口服抗凝剂的出现，可能改变VTE的治疗策略。然而，目前的真实世界的实践模式的VTE在亚洲countries.Methods和ResultsThe JROAD-DPC（日本登记所有心脏和血管疾病诊断程序组合）的数据有限，是一个全国性的索赔数据库，从1022家医院在日本2012年4月至2017年3月。我们确定了54369例入院时根据国际疾病分类第十版（ICD-10）编码诊断为VTE的住院患者。平均年龄为69.1 ± 15.6岁，59%为女性，平均体重指数为23.5 ± 5.0 kg/m2。随着时间的推移，深静脉血栓形成患者的比例从2012年的72%下降到2017年的38%。在直接口服抗凝剂发布后，在出院时接受抗凝治疗的患者中，接受直接口服抗凝剂的患者比例急剧增加，2017年分别有35%、22%和27%的患者使用edoxaban、rivaroxaban和apixaban。另一方面，接受华法林治疗的患者比例从2012年的94%下降至2017年的15%。肺栓塞患者的中位住院时间从2012年的20天减少到2017年的13天，深静脉血栓形成患者的中位住院时间从2012年的14天减少到2017年的12天。肺栓塞的住院中位费用随着时间的推移适度下降，而深静脉血栓形成的住院中位费用随着时间的推移略有下降。结论基于索赔的全国数据库提供了日本当前静脉血栓栓塞的实践模式，揭示了直接口服抗凝剂发布后的动态变化。
BackgroundRecently, direct oral anticoagulants have been introduced for venous thromboembolism (VTE), which might change the management strategies of VTE. However, there have been limited data on the current real-world practice pattern for VTE in Asian countries.Methods and ResultsThe JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases\xF6Diagnosis Procedure Combination) is a nationwide claim database from 1022 hospitals in Japan between April 2012 and March 2017. We identified 54 369 patients who were hospitalized with a diagnosis of VTE at admission based on the International Classification of Diseases, Tenth Revision (ICD-10) code. The mean age was 69.1 +/- 15.6 years, 59% were women, and mean body mass index was 23.5 +/- 5.0 kg/m(2). The proportion of patients with deep vein thrombosis decreased over time from 72% in 2012 to 38% in 2017. After the release of direct oral anticoagulants, the proportion of patients receiving direct oral anticoagulants increased dramatically among patients with anticoagulation therapy at discharge with the use of edoxaban, rivaroxaban, and apixaban in 35%, 22%, and 27% of patients, respectively, in 2017. On the other hand, the proportion of patients receiving warfarin decreased from 94% in 2012 to 15% in 2017. The median length of a hospital stay decreased over time from 20 days in 2012 to 13 days in 2017 in patients with pulmonary embolism, and from 14 days in 2012 to 12 days in 2017 in patients with deep vein thrombosis. The median cost of hospitalization for pulmonary embolism moderately decreased over time, whereas that for deep vein thrombosis slightly decreased over time.ConclusionsA nationwide claim-based database provided the current practice pattern for VTE in Japan, which revealed dynamic changes after the release of direct oral anticoagulants.