Brown Joshua D, Shewale Anand R, Dherange Parinita, Talbert Jeffery C
Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 789 S. Limestone St #292E, Lexington, KY, 40536, USA.
Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Drugs Aging. 2016 Jun;33(6):427-36. doi: 10.1007/s40266-016-0369-y.
Direct oral anticoagulants (DOACs) have seen rapid uptake for the prevention of stroke associated with non-valvular atrial fibrillation (NVAF). It is unclear whether use of DOACs represents direct therapeutic substitution over warfarin or if this coincides with an increase in overall treatment rates. This study sought to describe the difference in oral anticoagulant (OAC) use in the pre-DOAC and post-DOAC eras.
Incident cases of NVAF were identified from the Truven Marketscan database during the years 2005-2009 ('pre-DOAC') and 2013 ('post-DOAC'). Demographic and clinical characteristics were compared for the overall cohorts and among those who did and did not receive OAC in both time periods. OAC treatment was observed by stroke (CHA2DS2-VASc) and bleed risk (HAS-BLED) scores. Logistic regression was used to compare the individual characteristics associated with OAC use between the study periods.
During the pre- and post-DOAC eras, 105,610 and 11,992 NVAF patients were identified. OAC treatment increased from 42.2 to 54.0 % (absolute change 11.8 %, relative change 28.0 %) from the pre- to post-DOAC periods without meaningful differences between the populations. Larger relative increases in OAC treatment were observed for those at high risk of stroke (33.9 % increase) and for those with moderate (30.4 % increase) to high risk (28.6 % increase) of bleed. Other than time period of diagnosis, no patient characteristics differed between those treated with OACs in the pre and post periods.
There has been an overall increase in OAC use in the NVAF population, attributable to both favorable randomized trial results and aggressive marketing of DOACs in the USA.
直接口服抗凝剂（DOACs）已迅速被用于预防非瓣膜性心房颤动（NVAF）相关的中风。目前尚不清楚DOACs的使用是直接替代华法林进行治疗，还是这与总体治疗率的增加相吻合。本研究旨在描述DOACs时代之前和之后口服抗凝剂（OAC）使用情况的差异。
从Truven Marketscan数据库中识别出2005 - 2009年（“DOACs时代之前”）和2013年（“DOACs时代之后”）的NVAF新发病例。比较了两个时期总体队列以及接受和未接受OAC治疗患者的人口统计学和临床特征。通过中风（CHA2DS2 - VASc）和出血风险（HAS - BLED）评分观察OAC治疗情况。采用逻辑回归比较研究期间与OAC使用相关的个体特征。
在DOACs时代之前和之后，分别识别出105,610例和11,992例NVAF患者。从DOACs时代之前到之后，OAC治疗率从42.2%增加到54.0%（绝对变化11.8%，相对变化28.0%），不同人群之间无显著差异。中风高危患者（增加33.9%）以及出血风险为中度（增加30.4%）至高风险（增加28.6%）的患者中，OAC治疗的相对增幅更大。除诊断时间外，DOACs时代之前和之后接受OAC治疗的患者在其他患者特征方面无差异。
NVAF人群中OAC的总体使用有所增加，这归因于有利的随机试验结果以及DOACs在美国的积极推广。
