Groetzinger Lara M, Miller Taylor J, Rivosecchi Ryan M, Smith Roy E, Gladwin Mark T, Rivera-Lebron Belinda N
1 Medical Intensive Care Unit, Department of Pharmacy, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, PA, USA.
2 Cardiology, Department of Pharmacy, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, PA, USA.
Clin Appl Thromb Hemost. 2018 Sep;24(6):908-913. doi: 10.1177/1076029618755311. Epub 2018 Feb 18.
Little data exist on the use of direct oral anticoagulant (DOAC) factor Xa inhibitors for submassive pulmonary embolism (PE) after catheter-directed thrombolysis (CDT). The objective of this evaluation was to determine whether the transition from parenteral anticoagulation to DOACs for submassive PE after CDT would decrease hospital length of stay (LOS) compared to warfarin.
A retrospective review of patients diagnosed with submassive PE who underwent CDT was conducted from January 1, 2012, to February 28, 2017. Hospital LOS and major and minor bleeding events were recorded during hospitalization and at 90 days.
Sixty-two patients met the inclusion criteria, 36 in warfarin group and 26 in the DOAC group. Overall, patients receiving rivaroxaban or apixaban had a shorter median hospital LOS compared to warfarin (4.0 vs 6.1 days, P = .002). In the multivariate regression analysis, administration of DOAC was an independent predictor of decreased hospital LOS, β: -2.1, 95% confidence interval (-3.5 to -0.7).
Among patients with submassive PE, initiation of a DOAC shortly after CDT may result in a decreased hospital LOS compared to parenterally bridged warfarin.
关于导管直接溶栓（CDT）后使用直接口服抗凝剂（DOAC）Xa因子抑制剂治疗次大面积肺栓塞（PE）的数据较少。本评估的目的是确定与华法林相比，CDT后次大面积PE从肠外抗凝过渡到DOAC是否会缩短住院时间（LOS）。
对2012年1月1日至2017年2月28日期间诊断为次大面积PE并接受CDT的患者进行回顾性研究。记录住院期间及90天时的住院LOS以及严重和轻微出血事件。
62例患者符合纳入标准，华法林组36例，DOAC组26例。总体而言，与华法林相比，接受利伐沙班或阿哌沙班的患者中位住院LOS较短（4.0天对6.1天，P = .002）。在多变量回归分析中，使用DOAC是住院LOS降低的独立预测因素，β：-2.1，95%置信区间（-3.5至-0.7）。
在次大面积PE患者中，与肠外桥接华法林相比，CDT后不久开始使用DOAC可能会缩短住院LOS。
