Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America.
HealthCore, Inc, Wilmington, DE, United States of America.
PLoS One. 2018 Mar 28;13(3):e0193912. doi: 10.1371/journal.pone.0193912. eCollection 2018.
Different outcomes among patients hospitalized for bleeding after starting anticoagulation could influence choice of anticoagulant. We compared length of hospitalization, proportion of Intensive Care Unit (ICU) admissions, ICU length of stay, and 30- and 90-day mortality for adults with atrial fibrillation hospitalized for bleeding after starting warfarin, dabigatran, or rivaroxaban.
An US commercial database of 38 million members from 1 November 2010 to 31 March 2014 was used to examine adults with atrial fibrillation hospitalized for bleeding after starting warfarin (2,446), dabigatran (442), or rivaroxaban (256). Outcomes included difference in mean total length of hospitalization, proportion of ICU admissions, mean length of ICU stay, and all-cause 30- and 90-day mortality.
Warfarin users were older and had more comorbidities. Multivariable regression modeling with propensity score weighting showed warfarin users were hospitalized 2.0 days longer (95% CI 1.8-2.3; p < 0.001) than dabigatran users and 2.6 days longer (95% CI 2.4-2.9; p < 0.001) than rivaroxaban users. Dabigatran users were hospitalized 0.6 days longer (95% CI 0.2-1.0; p = 0.001) than rivaroxaban users. There were no differences in the proportion of ICU admissions. Among ICU admissions, warfarin users stayed 3.0 days (95% CI 1.9-3.9; p < 0.001) longer than dabigatran users and 2.4 days longer (95% CI 0.9-3.7; p = 0.003) than rivaroxaban users. There was no difference in ICU stay between dabigatran and rivaroxaban users. There were no differences in 30- and 90-day all-cause mortality.
Rivaroxaban and dabigatran were associated with shorter hospitalizations; however, there were no differences in 30- and 90-day mortality. These findings suggest bleeding associated with the newer agents is not more dangerous than bleeding associated with warfarin.
因抗凝而出血住院的患者结局不同，可能会影响抗凝药物的选择。我们比较了华法林、达比加群和利伐沙班起始抗凝后出血住院的成人患者的住院时间、重症监护病房（ICU）入住率、ICU 住院时间、30 天和 90 天死亡率。
使用 2010 年 11 月 1 日至 2014 年 3 月 31 日期间的美国一个拥有 3800 万成员的商业数据库，纳入华法林（2446 例）、达比加群（442 例）或利伐沙班（256 例）起始抗凝后出血住院的成人患者。结局包括总住院时间、ICU 入住率、ICU 住院时间、全因 30 天和 90 天死亡率的差异。
华法林使用者年龄较大且合并症更多。多变量回归模型和倾向评分加权显示，与达比加群使用者相比，华法林使用者的住院时间延长 2.0 天（95%CI 1.8-2.3；p<0.001），与利伐沙班使用者相比，住院时间延长 2.6 天（95%CI 2.4-2.9；p<0.001）。与利伐沙班使用者相比，达比加群使用者的住院时间延长 0.6 天（95%CI 0.2-1.0；p=0.001）。两组 ICU 入住率无差异。在 ICU 入住患者中，华法林使用者的 ICU 住院时间延长 3.0 天（95%CI 1.9-3.9；p<0.001），达比加群使用者延长 2.4 天（95%CI 0.9-3.7；p=0.003）。达比加群和利伐沙班使用者的 ICU 住院时间无差异。两组 30 天和 90 天全因死亡率无差异。
利伐沙班和达比加群与较短的住院时间相关；然而，30 天和 90 天死亡率无差异。这些发现表明，新型抗凝药相关出血并不比华法林相关出血更危险。
