Kucher Nils, Aujesky Drahomir, Beer Jürg H, Mazzolai Lucia, Baldi Thomas, Banyai Martin, Hayoz Daniel, Kaeslin Thomas, Korte Wolfgang, Escher Robert, Husmann Marc, Frauchiger Beat, Baumgartner Iris, Spirk David
Nils Kucher, MD, Division of Vascular Medicine, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland, Tel.: +41 31 632 7963, Fax: +41 31 632 4380, E-mail:
Thromb Haemost. 2016 Aug 30;116(3):472-9. doi: 10.1160/TH16-03-0209. Epub 2016 Jun 23.
We investigated three-month clinical outcomes in patients with venous thromboembolism (VTE) treated with rivaroxaban or conventional anticoagulation in routine clinical practice. Between November 2012 and February 2015, 2,062 consecutive patients with VTE from 11 acute care hospitals in Switzerland were enrolled in the SWIss Venous ThromboEmbolism Registry (SWIVTER). Overall, 417 (20 %) patients were treated with rivaroxaban. In comparison to 1,645 patients on conventional anticoagulation, patients on rivaroxaban were younger (56 ± 18 vs. 65 ± 17 years; p<0.001), less often had pulmonary embolism (38 % vs 66 %; p<0.001), hypertension (26 % vs 41 %; p<0.001), cancer (10 % vs 28 %; p<0.001), congestive heart failure (10 % vs 17 %; p=0.001), diabetes (8 % vs 15 %; p<0.001), chronic lung disease (7 % vs 13 %; p=0.001), renal insufficiency (7 % vs 13 %; p=0.001), recent surgery (7 % vs 14 %; p<0.001), and acute coronary syndrome (1 % vs 4 %; p=0.009). VTE reperfusion therapy was more frequently used (28 % vs 9 %; p<0.001) and indefinite-duration anticoagulation treatment less often planned (26 % vs 39 %; p<0.001), respectively. In the propensity score-adjusted population, the risk of recurrent VTE was similar in patients on rivaroxaban vs conventional anticoagulation (1.2 % vs 2.1 %, hazard ratio [HR] 0.55, 95 % confidence interval [CI] 0.18-1.65; p=0.29); the risk of major bleeding was also similar, respectively (0.5 % vs 0.5 %, HR 1.00, 95 %CI 0.14-7.07; p=1.00). Conventional anticoagulation is still frequently used for the treatment of VTE, particularly in the elderly and those with comorbidities. Early clinical outcomes were comparable between propensity score-adjusted patient populations on rivaroxaban and conventional anticoagulation.
我们在常规临床实践中研究了接受利伐沙班或传统抗凝治疗的静脉血栓栓塞症（VTE）患者的三个月临床结局。2012年11月至2015年2月期间，瑞士11家急症医院的2062例连续VTE患者被纳入瑞士静脉血栓栓塞症登记处（SWIVTER）。总体而言，417例（20%）患者接受了利伐沙班治疗。与1645例接受传统抗凝治疗的患者相比，接受利伐沙班治疗的患者更年轻（56±18岁 vs. 65±17岁；p<0.001），肺栓塞（38% vs 66%；p<0.001）、高血压（26% vs 41%；p<0.001）、癌症（10% vs 28%；p<0.001）、充血性心力衰竭（10% vs 17%；p=0.001）、糖尿病（8% vs 15%；p<0.001）、慢性肺病（7% vs 13%；p=0.001）、肾功能不全（7% vs 13%；p=0.001）、近期手术（7% vs 14%；p<0.001）及急性冠状动脉综合征（1% vs 4%；p=0.009）的发生率更低。VTE再灌注治疗的使用频率更高（28% vs 9%；p<0.001），而计划进行无限期抗凝治疗的频率更低（26% vs 39%；p<0.001）。在倾向评分调整后的人群中，接受利伐沙班治疗的患者与接受传统抗凝治疗的患者复发性VTE风险相似（1.2% vs 2.1%，风险比[HR]0.55，95%置信区间[CI]0.18 - 1.65；p=0.29）；大出血风险也相似（0.5% vs 0.5%，HR 1.00，95%CI 0.14 - 7.07；p=1.00）。传统抗凝治疗仍常用于VTE的治疗，尤其是在老年人和有合并症的患者中。在倾向评分调整后的接受利伐沙班治疗和传统抗凝治疗的患者人群中，早期临床结局具有可比性。
