Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
Am J Med. 2018 Jul;131(7):787-794.e4. doi: 10.1016/j.amjmed.2018.01.041. Epub 2018 Feb 21.
The effectiveness of rivaroxaban to reduce post-thrombotic syndrome in patients with venous thromboembolism is largely unknown. We compared rates of post-thrombotic syndrome in patients given rivaroxaban versus warfarin in a cohort of patients with incident venous thromboembolism receiving routine clinical care.
We linked Danish nationwide registries to identify all patients with incident venous thromboembolism who were new users of rivaroxaban or warfarin and compared rates of post-thrombotic syndrome using an inverse probability of treatment-weighting approach to account for baseline confounding.
We identified 19,957 oral anticoagulation-naive patients with incident venous thromboembolism treated with warfarin or rivaroxaban (mean age, 64 years; 48% were female, 45.5% had pulmonary embolism). The propensity-weighted rate of post-thrombotic syndrome at 3 years follow-up was 0.53 incidents per 100 person-years with rivaroxaban versus 0.55 per 100 person-years with warfarin, yielding a hazard rate of 0.88 (95% confidence interval, 0.66-1.17). This association remained consistent across types of venous thromboembolism (deep venous thrombosis vs pulmonary embolism, and provoked vs unprovoked venous thromboembolism) and when censoring patients with recurrent venous thromboembolism.
In this clinical practice setting, rivaroxaban was associated with lower but statistically nonsignificant rates of post-thrombotic syndrome, which did not appear to be mediated only by an effect on recurrent venous thromboembolism.
利伐沙班在降低静脉血栓栓塞患者的血栓后综合征方面的有效性在很大程度上尚不清楚。我们比较了在接受常规临床治疗的静脉血栓栓塞患者队列中，给予利伐沙班与华法林的患者的血栓后综合征发生率。
我们将丹麦全国性登记处进行了关联，以确定所有新使用利伐沙班或华法林的静脉血栓栓塞患者，并使用逆概率治疗加权法来比较血栓后综合征的发生率，以纠正基线混杂因素。
我们确定了 19957 名口服抗凝剂初治的静脉血栓栓塞患者，他们接受了华法林或利伐沙班治疗（平均年龄 64 岁，48%为女性，45.5%患有肺栓塞）。利伐沙班组 3 年随访时的血栓后综合征发生率为每 100 人年 0.53 例，华法林组为每 100 人年 0.55 例，风险比为 0.88（95%置信区间，0.66-1.17）。这种关联在各种类型的静脉血栓栓塞（深静脉血栓形成与肺栓塞，以及有或无诱因的静脉血栓栓塞）和当对复发性静脉血栓栓塞的患者进行删失时仍然一致。
在这种临床实践环境下，利伐沙班与较低但无统计学意义的血栓后综合征发生率相关，而这种相关性似乎不仅仅是通过对复发性静脉血栓栓塞的影响来介导的。
