Ng Diana Leh-Ching, Gan Gin-Gin, Chai Chee-Shee, Chee Kok-Han, Tan Kok-Leng, Tan Seng-Beng, Bee Ping-Chong
Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Patient Prefer Adherence. 2019 Aug 14;13:1363-1373. doi: 10.2147/PPA.S204246. eCollection 2019.
Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC).
This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2).
A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, =0.083; mental QOL, =0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, =0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, =0.069).
Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes.
近年来，由于医疗进步使预期寿命延长，长期口服抗凝治疗患者的生活质量（QOL）受到了更多关注。本研究旨在比较长期服用华法林与直接口服抗凝剂（DOAC）的患者的生活质量、治疗满意度、住院率和出血率。
这是一项横断面研究，研究对象为2016年7月1日至2018年6月30日在马来亚大学医学中心心脏病诊所和抗凝诊所接受长期抗凝治疗的非瓣膜性心房颤动（NVAF）或静脉血栓栓塞（VTE）患者。使用简短健康调查问卷12（SF12）评估患者的生活质量，同时使用抗凝治疗认知问卷2（PACT-Q2）评估治疗满意度。
共招募了208名患者；52.4%接受华法林治疗，47.6%接受DOAC治疗。基于SF12，华法林组和DOAC组的生活质量无显著差异（身体生活质量，=0.083；精神生活质量，=0.665）。然而，基于PACT-Q2，DOAC组患者对治疗的满意度明显高于华法林组（=0.004）。华法林组的住院率显著高于DOAC组（15.6%对3.0%，=0.002）。华法林组临床相关的轻微出血和严重出血事件略高于DOAC组，但无显著差异（66.7%对40.0%，=0.069）。
与华法林相比，DOAC治疗NVAF和VTE的生活质量相当，治疗满意度更高，住院率更低，出血事件减少的趋势不显著。
