Admassie Endalkachew, Chalmers Leanne, Bereznicki Luke R
1 Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
2 School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia.
J Cardiovasc Pharmacol Ther. 2018 Jul;23(4):329-336. doi: 10.1177/1074248418769638. Epub 2018 Apr 11.
Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study.
The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015).
Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers.
Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.
尽管近年来心房颤动（AF）患者中抗凝治疗的应用有所增加，但临床试验之外关于血栓栓塞和死亡率发生率的当代数据有限。本研究旨在调查直接口服抗凝剂（DOACs）对塔斯马尼亚心房颤动研究中AF患者临床结局的影响。
对2011年至2015年间在澳大利亚塔斯马尼亚州公立医院就诊的所有原发性或继发性诊断为AF的患者的病历进行回顾性审查。我们调查了该州主要教学医院皇家霍巴特医院收治患者的总体血栓栓塞事件（TEs）、缺血性中风/短暂性脑缺血发作（IS/TIA）和死亡率发生率。我们比较了两个时间段的结局：DOACs可用之前（DOACs前；2011年至2013年年中）和政府补贴后其普遍可用之后（DOACs后；2013年年中至2015年）。
在整个研究期间收治的2390例AF患者中，对942例新开具抗血栓药物的患者进行了随访（分别来自DOACs前和DOACs后时间段的465例和477例）。我们观察到，与DOACs前时期相比，DOACs后总体TE（每100患者年[PY]分别为3.2和1.7；P <.001）和IS/TIA（每100 PY分别为2.1和1.3；P =.022）的发生率显著降低。DOACs后全因死亡率显著降低（每100 PY分别为2.9和2.2，P =.028）。在本研究人群中，年龄增加、既往中风以及DOACs前时期入院都是TE、IS/TIA和死亡率的危险因素。与既往吸烟者和非吸烟者相比，当前吸烟者发生IS/TIA的风险增加了一倍多（风险比：2.54；95%置信区间：1.17 - 5.52）。
在该人群中DOACs广泛应用后，血栓栓塞事件和全因死亡率有所降低。
