Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Thromb Res. 2018 Jul;167:135-141. doi: 10.1016/j.thromres.2018.05.013. Epub 2018 May 19.
Currently, direct oral anticoagulants (DOACs) are the treatment of choice for venous thromboembolism (VTE) in the Netherlands. The main advantages of DOACs over vitamin K antagonists (VKAs) are that they are safer than VKA and that neither monitoring nor dose titrations are needed. A main drawback is a potential risk of lower drug persistence, as compared with VKA treatment, which is strictly controlled by anticoagulation clinics in the Netherlands.
The primary aim of this study was to audit the persistence to DOAC treatment for acute VTE during the first 2 months in daily clinical practice.
Dispensing data from the Dutch Foundation of Pharmaceutical Statistics were used to monitor persistence to DOAC for treatment of VTE from 1 January 2012-1 April 2016. Non-persistence was defined as the cumulative incidence of patients who completely stopped DOAC or VKA treatment. In addition, we estimated the persistence to VKA treatment for VTE in data from the Anticoagulation Clinic Leiden.
1834 patients were selected as DOAC users for the indication VTE. The 2-month cumulative incidence of completely stopping DOAC was 20% (95% confidence interval [CI] 18-24). In the population of 4910 VKA users, 9.1% (95%CI 8.3-9.9) stopped prematurely with VKA.
The stopping rate of 20% we found is in line with other cardiovascular treatments. Further research into the reasons and consequences of prematurely stopping DOAC treatment for acute VTE is urgently needed.
目前，直接口服抗凝剂（DOAC）是荷兰治疗静脉血栓栓塞症（VTE）的首选药物。DOAC 相对于维生素 K 拮抗剂（VKA）的主要优势在于它们比 VKA 更安全，且无需监测或剂量调整。一个主要缺点是与 VKA 治疗相比，药物持续存在的潜在风险较低，而荷兰的抗凝诊所对 VKA 治疗进行了严格控制。
本研究的主要目的是在日常临床实践中，对急性 VTE 患者使用 DOAC 治疗的前 2 个月的药物持续情况进行审核。
利用荷兰药物统计基金会的配药数据，监测 2012 年 1 月 1 日至 2016 年 4 月 1 日期间，DOAC 治疗 VTE 的持续情况。药物持续治疗被定义为完全停止 DOAC 或 VKA 治疗的患者的累积发生率。此外，我们还根据莱顿抗凝诊所的数据，估计 VKA 治疗 VTE 的持续情况。
共选择了 1834 例 VTE 患者作为 DOAC 使用者。完全停止 DOAC 的 2 个月累积发生率为 20%（95%置信区间 [CI] 18-24）。在 4910 例 VKA 使用者中，有 9.1%（95%CI 8.3-9.9）过早停止使用 VKA。
我们发现的停药率与其他心血管治疗相符。迫切需要进一步研究急性 VTE 患者过早停止 DOAC 治疗的原因和后果。
