Laliberté François, Pilon Dominic, Raut Monika K, Nelson Winnie W, Olson William H, Germain Guillaume, Schein Jeff R, Lefebvre Patrick
Groupe d'analyse, Ltée, Montreal, Quebec, Canada.
Hosp Pract (1995). 2014 Aug;42(3):17-25. doi: 10.3810/hp.2014.08.1114.
Warfarin has been the only anticoagulant used for decades to prevent strokes and systemic embolisms in nonvalvular atrial fibrillation (NVAF) patients. Compared with rivaroxaban, warfarin has a narrow therapeutic range and many genetic and food-drug interactions that could potentially prolong hospital length of stay (LOS).
To compare hospital LOS between NVAF patients who were administered rivaroxaban versus warfarin with and without pretreatment of parenteral anticoagulant agents in a population of rivaroxaban-treated patients.
A retrospective matched-cohort analysis was conducted using the Premier Perspective Comparative Hospital Database from November 2010 to September 2012. Adult patients were included in the study if they had a hospitalization for NVAF. Rivaroxaban users were matched with up to 4 warfarin users based on propensity score analyses. Patients with and without pretreatment of parenteral anticoagulant agents were evaluated separately. Hospital LOS was compared between treatment groups using generalized estimating equations.
The matched cohorts' characteristics were well balanced. Among the matched rivaroxaban and warfarin users who were administered parenteral agents, the mean age of the cohorts was 70 years and 47% of patients were female, whereas in the sample of patients who were not administered parenteral agents, the mean age was 72 years and 50% of patients were female. In the sample of patients who were administered parenteral agents, rivaroxaban users had significantly shorter hospital LOS (LOS difference: 1.38 days, P < 0.001) compared with warfarin users among rivaroxaban-treated patients. No significant difference in LOS was found in the sample of patients who were not administered parenteral anticoagulant agents (P = 0.169).
In the study sample of NVAF patients who were administered parenteral anticoagulant agents, rivaroxaban was associated with a significantly shorter hospital LOS compared with warfarin. The difference in LOS was not statistically significant in the sample of patients who were not administered parenteral anticoagulant agents.
几十年来，华法林一直是唯一用于预防非瓣膜性心房颤动（NVAF）患者中风和全身性栓塞的抗凝剂。与利伐沙班相比，华法林的治疗窗较窄，且存在许多可能延长住院时间（LOS）的基因和食物 - 药物相互作用。
在接受利伐沙班治疗的患者群体中，比较接受利伐沙班与华法林治疗且使用或未使用肠外抗凝剂预处理的NVAF患者的住院时间。
使用2010年11月至2012年9月的Premier Perspective Comparative Hospital数据库进行回顾性匹配队列分析。成年NVAF住院患者纳入本研究。基于倾向得分分析，将利伐沙班使用者与最多4名华法林使用者进行匹配。分别评估使用和未使用肠外抗凝剂预处理的患者。使用广义估计方程比较治疗组之间的住院时间。
匹配队列的特征均衡良好。在接受肠外制剂治疗的匹配利伐沙班和华法林使用者中，队列的平均年龄为70岁，47%的患者为女性，而在未接受肠外制剂治疗的患者样本中，平均年龄为72岁，50%的患者为女性。在接受肠外制剂治疗的患者样本中，与华法林使用者相比，利伐沙班使用者的住院时间显著缩短（住院时间差异：1.38天，P < 0.001）。在未接受肠外抗凝剂治疗的患者样本中，住院时间未发现显著差异（P = 0.169）。
在接受肠外抗凝剂治疗的NVAF患者研究样本中，与华法林相比，利伐沙班与显著缩短的住院时间相关。在未接受肠外抗凝剂治疗的患者样本中，住院时间差异无统计学意义。
