a Division of Epidemiology & Community Health , School of Public Health, University of Minnesota , Minneapolis , MN, USA.
b Division of Hematology/Oncology, Department of Medicine & Department of Pathology and Laboratory Medicine , Larner College of Medicine at the University of Vermont , Colchester , VT , USA.
Curr Med Res Opin. 2019 May;35(5):837-845. doi: 10.1080/03007995.2018.1541445. Epub 2018 Dec 3.
Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). This study evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk.
Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban, and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHADS-VASc, and high-dimensional propensity scores. The final analysis included 117,912 AF patients.
In total, 1357 VTE events accrued over a mean follow-up of 484 days. In multivariable-adjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95% confidence interval) = 0.55 (0.47-0.66)] and apixaban [0.51 (0.39-0.68)], but similar among new users of rivaroxaban [1.01 (0.87-1.19)]. In head-to-head DOAC comparisons, VTE risk was lower among users of dabigatran [0.48 (0.36-0.64)] and apixaban [0.61 (0.47-0.78)] vs rivaroxaban. Findings were mostly similar across patient sub-groups.
In this large practice-based population of AF patients prescribed OACs for primary prevention of stroke and systemic embolization, subsequent risk of VTE was lowest among those prescribed apixaban and dabigatran, while risk was similar with prescriptions for warfarin and rivaroxaban. Among AF patients prescribed OACs, lowering the risk of VTE may be an additional benefit of apixaban and dabigatran, beyond the reduced bleeding risk observed in randomized clinical trials.
为预防心源性栓塞并发症而给房颤 (AF) 患者开具的口服抗凝药物 (OAC) 可能还有预防静脉血栓栓塞症 (VTE) 的额外益处。本研究评估了在接受 OAC 治疗的 AF 患者中，OAC 类型是否与随后的 VTE 风险相关。
通过 MarketScan 行政索赔数据库，确定 2010 年至 2015 年 9 月期间接受 OAC 治疗的非瓣膜性 AF 患者。OAC 包括华法林和直接口服抗凝剂 (DOAC：达比加群、利伐沙班和阿哌沙班)。通过 ICD-9-CM 代码定义 VTE 事件。患者按年龄、性别、CHA2DS2-VASc 评分和高维倾向评分进行匹配。最终分析纳入了 117912 例 AF 患者。
在平均 484 天的随访中，共发生 1357 例 VTE 事件。在多变量调整后的倾向评分匹配 Cox 模型中，与新使用华法林的患者相比，新使用达比加群的患者发生 VTE 的风险较低[风险比 (95%置信区间) = 0.55 (0.47-0.66)]，新使用阿哌沙班的患者也较低[0.51 (0.39-0.68)]，而新使用利伐沙班的患者则相似[1.01 (0.87-1.19)]。在直接口服抗凝剂的头对头比较中，达比加群的患者[0.48 (0.36-0.64)]和阿哌沙班的患者[0.61 (0.47-0.78)]的 VTE 风险低于利伐沙班。在亚组患者中，研究结果基本一致。
在这项基于大量实践的、为预防中风和全身性栓塞而开具 OAC 药物的 AF 患者中，阿哌沙班和达比加群的患者 VTE 风险最低，而华法林和利伐沙班的患者 VTE 风险相似。在接受 OAC 治疗的 AF 患者中，与观察到的出血风险降低相比，降低 VTE 风险可能是阿哌沙班和达比加群的额外益处。
