Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States of America.
Kantar, LLC, San Francisco, CA, United States of America.
Thromb Res. 2019 Oct;182:95-100. doi: 10.1016/j.thromres.2019.08.006. Epub 2019 Aug 13.
Understanding potential harms associated with common anticoagulation treatment patterns in patients with venous thromboembolism (VTE) is important for multiple stakeholders. The purpose of this study is to report associations between different anticoagulation patterns and bleeding and emotional harms based on patients' self-reported care experiences.
Patients at least 18 years of age who had experienced a VTE event in the past two years and completed a national online survey between May and July 2016 were analyzed. The survey assessed the prevalence of self-reported bleeding and emotional harms associated with self-reported anticoagulation treatment patterns and other variables.
Patients mean age was 52.4 (standard deviation 14.4) years and most were female (56.7%) and Caucasian (88.6%). Anticoagulant treatment patterns included warfarin (38.7%), direct oral anticoagulants (26.1%), and those who switched between anticoagulants (17.9%). Self-reported bleeding and emotional harms occurred in 63.6% and 56.3% of patients, respectively. Younger age, experiencing VTE more recently, and a prior history of anxiety, depression, or stroke were associated with increased odds of experiencing bleeding or emotional harm. Compared to warfarin, switching between anticoagulant types was associated with approximately twice the odds of experiencing bleeding harm, while DOAC therapy was associated with lower odds of experiencing emotional harm.
Self-reported bleeding and emotional harms occurred commonly during VTE treatment and were associated with identifiable clinical, demographic, and psychosocial characteristics such as younger age, history of depression and/or anxiety, and more recent VTE diagnosis. Switching between anticoagulants may be a marker for increased harm risk.
了解静脉血栓栓塞症 (VTE) 患者常见抗凝治疗模式相关的潜在危害对多方利益相关者都很重要。本研究的目的是根据患者的自我报告护理经验，报告不同抗凝模式与出血和情绪伤害之间的关联。
分析了至少 18 岁、过去两年内经历过 VTE 事件且于 2016 年 5 月至 7 月间完成全国性在线调查的患者。该调查评估了与自我报告抗凝治疗模式和其他变量相关的自我报告出血和情绪伤害的发生率。
患者的平均年龄为 52.4（标准差 14.4）岁，大多数为女性（56.7%）和白人（88.6%）。抗凝治疗模式包括华法林（38.7%）、直接口服抗凝剂（26.1%）和抗凝药物转换（17.9%）。分别有 63.6%和 56.3%的患者报告出现出血和情绪伤害。年龄较小、最近经历 VTE 且有焦虑、抑郁或中风病史与出血或情绪伤害的风险增加有关。与华法林相比，抗凝药物转换与出血伤害风险增加约两倍相关，而 DOAC 治疗与情绪伤害风险降低相关。
在 VTE 治疗期间，自我报告的出血和情绪伤害很常见，与可识别的临床、人口统计学和心理社会特征相关，如年龄较小、有抑郁和/或焦虑病史以及最近的 VTE 诊断。抗凝药物转换可能是危害风险增加的标志。
