Schaefer Jordan K, Sood Suman L, Haymart Brian, Gu Xiaokui, Kong Xiaowen, Kline-Rogers Eva, Almany Steven, Kozlowski Jay, Krol Gregory D, Kaatz Scott, Froehlich James B, Barnes Geoffrey D
Division of Hematology/Oncology and.
Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI.
Blood Adv. 2017 Dec 7;1(26):2536-2540. doi: 10.1182/bloodadvances.2017012377. eCollection 2017 Dec 12.
Clinical factors and patient preferences are important for selecting oral anticoagulants for venous thromboembolism (VTE) and atrial fibrillation (AF). The relative association of sociodemographic factors with anticoagulant use is unknown. We evaluated a prospective cohort to compare sociodemographic variables in patients who continued on warfarin for AF or VTE to those who transitioned to 1 of the direct oral anticoagulants (DOACs). Adult patients, newly started on warfarin, were enrolled through 6 anticoagulation clinics across Michigan. Of 8468 patients, 53.3% had AF, 45.6% had VTE, and 1.1% had both. Of these, 696 (8.2%) switched from warfarin to a DOAC. There were no significant differences between switchers and nonswitchers for percentage of time with a therapeutic international normalized ratio on warfarin, urban-rural residence status, or health insurance. Switchers were more often white (83.3% vs 77.7%; < .001), partnered (67.3% vs 59.2%; < .001), or resided in a zip code with a higher median household income ( < .001). The results show that sociodemographic factors, such as race, partnered status, and income are associated with a patient's likelihood of switching to a DOAC vs remaining on warfarin therapy. Although clinical factors predominate, the reason for, and impact of, these observed variations in care requires further investigation.
临床因素和患者偏好对于选择用于静脉血栓栓塞（VTE）和心房颤动（AF）的口服抗凝剂很重要。社会人口统计学因素与抗凝剂使用之间的相对关联尚不清楚。我们评估了一个前瞻性队列，以比较继续使用华法林治疗AF或VTE的患者与转而使用直接口服抗凝剂（DOACs）之一的患者的社会人口统计学变量。新开始使用华法林的成年患者通过密歇根州的6家抗凝诊所入组。在8468名患者中，53.3%患有AF，45.6%患有VTE，1.1%两者都有。其中，696名（8.2%）从华法林转而使用DOAC。在华法林治疗期间达到治疗性国际标准化比值的时间百分比、城乡居住状况或医疗保险方面，转用者和未转用者之间没有显著差异。转用者更常为白人（83.3%对77.7%；P<0.001）、有伴侣（67.3%对59.2%；P<0.001）或居住在家庭收入中位数较高的邮政编码地区（P<0.001）。结果表明，社会人口统计学因素，如种族、伴侣状况和收入，与患者转而使用DOAC而非继续接受华法林治疗的可能性相关。尽管临床因素占主导地位，但这些观察到的护理差异的原因和影响需要进一步研究。
