Formerly Technical University of Munich, Munich, Germany.
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
J Thromb Haemost. 2019 Oct;17(10):1694-1706. doi: 10.1111/jth.14548. Epub 2019 Jul 23.
Parenteral anticoagulants and vitamin K antagonists (VKAs) have constituted the cornerstone of venous thromboembolism (VTE) treatment. Meanwhile, direct oral anticoagulants (DOACs) provide physicians with an alternative. The Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE observes real-world treatment practices.
Describe initial anticoagulation (AC) treatment patterns in VTE patients who received parenteral AC, VKAs, and/or DOACs within ±30 days of diagnosis.
VTE patients were categorized into parenteral AC only, parenteral AC with transition to VKA, VKA only, parenteral AC with transition to DOAC, and DOAC only.
A total of 9647 patients were initiated on AC treatment alone. 4781 (49.6%) patients received DOACs ± parenteral ACs; 3187 (33.0%), VKA ± parenteral ACs; and 1679 (17.4%) parenteral ACs alone. Rivaroxaban was the most frequently used DOAC (79.4%). DOACs were more frequently used in North America/Australia (58.1%), Europe (52.2%), and Asia (47.6%) than in Latin America (29.7%) and the Middle East/South Africa (32.5%). In patients with suspected VTE, most received parenteral AC monotherapy (67.7%). Patients with deep vein thrombosis were more likely to receive DOACs alone than those with pulmonary embolism with or without deep vein thrombosis (36.2% vs 25.9%). Active cancer patients received parenteral AC alone (58.9%), with 25.5% receiving DOAC ± parenteral AC and 12.8% parenteral AC and VKA. A total of 46.5% of pregnant patients received parenteral AC monotherapy, 34.0% were treated with VKA ± parenteral AC, and 19.5% received a DOAC (± parenteral AC).
AC treatment patterns vary by patient population, geographic region and site of VTE. Guidelines for AC therapy are not always adhered to.
肠外抗凝剂和维生素 K 拮抗剂（VKA）一直是静脉血栓栓塞症（VTE）治疗的基石。与此同时，直接口服抗凝剂（DOAC）为医生提供了另一种选择。全球抗凝剂注册研究（GARFIELD）-VTE 观察到了真实世界中的治疗实践。
描述诊断后 30 天内接受肠外抗凝剂、VKA 和/或 DOAC 初始抗凝（AC）治疗的 VTE 患者的 AC 治疗模式。
将 VTE 患者分为仅接受肠外 AC、肠外 AC 转为 VKA、仅接受 VKA、肠外 AC 转为 DOAC 和仅接受 DOAC。
共有 9647 例患者单独开始 AC 治疗。4781 例（49.6%）患者接受 DOAC+肠外 AC；3187 例（33.0%）患者接受 VKA+肠外 AC；1679 例（17.4%）患者单独接受肠外 AC。利伐沙班是最常用的 DOAC（79.4%）。在北美/澳大利亚（58.1%）、欧洲（52.2%）和亚洲（47.6%），DOAC 的使用频率高于拉丁美洲（29.7%）和中东/南非（32.5%）。在疑似 VTE 的患者中，大多数患者接受肠外 AC 单药治疗（67.7%）。与有或无深静脉血栓形成的肺栓塞患者相比，深静脉血栓形成患者更有可能单独接受 DOAC 治疗（36.2% vs. 25.9%）。患有活动性癌症的患者单独接受肠外 AC 治疗（58.9%），25.5%的患者接受 DOAC+肠外 AC 治疗，12.8%的患者接受肠外 AC 和 VKA 治疗。46.5%的孕妇接受肠外 AC 单药治疗，34.0%的患者接受 VKA+肠外 AC 治疗，19.5%的患者接受 DOAC（+肠外 AC）。
AC 治疗模式因患者人群、地理位置和 VTE 部位而异。AC 治疗指南并非总是得到遵守。
