Division of Pulmonary Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, NYU Langone, 301 East 17th Street, Suite 550, New York, NY, 10003, USA.
J Thromb Thrombolysis. 2020 Aug;50(2):399-407. doi: 10.1007/s11239-020-02045-3.
Direct oral anti-coagulants (DOACs) reduce hospital length-of-stay (LOS) in patients with acute pulmonary embolism (PE) in clinical trials. There is a paucity of literature describing real world utility of DOACs, particularly in intermediate-risk patients. To evaluate if the utilization of DOACs vs. non-DOACs in acute PE patients, reduces LOS without a difference in safety in patients defined as low and intermediate-risk of mortality by the European Society of Cardiology. This was a retrospective cohort study of prospectively collected data from a single center registry of consecutive adult outpatients diagnosed with acute PE who survived to hospital discharge. Primary outcome was median hospital LOS. Secondary outcomes were 30-day readmission, survival, and incidence of major and minor bleeding. There were 307 outpatients admitted with acute PE 88 (28.7%) low-risk, 213 (69.4%) intermediate-risk, and 6 (2.0%) high-risk. Two hundred and twenty-six (73.6%) received a DOAC. There was a statistically significant shorter median LOS in all patients treated with a DOAC (2.9 days, IQR 1.8-4.7) vs non-DOAC (4.9 days, IQR 3-8.9) (Generalized Linear Model p < 0.001). There was a shorter median LOS between intermediate-risk patients treated with a DOAC (3.6 days, IQR 2-5.8) vs non-DOAC (5, IQR 3-9). There was no difference in 30-day readmission, survival, or bleeding complications in both cohorts. There was a reduction in LOS in low and intermediate risk patients treated with a DOAC without a difference in 30-day safety and efficacy. Treating acute PE patients with DOACs including intermediate-risk patients, compared to conventional anticoagulation, may facilitate early discharge, and potentially reduce hospital costs.
直接口服抗凝剂 (DOAC) 可降低临床试验中急性肺栓塞 (PE) 患者的住院时间 (LOS)。关于 DOAC 在真实世界中的应用，特别是在中危患者中的应用，文献报道较少。本研究旨在评估 DOAC 与非 DOAC 在低危和中危欧洲心脏病学会 (ESC) 死亡率患者中的应用是否可降低 LOS，且不影响安全性。这是一项回顾性队列研究，对来自单中心连续门诊急性 PE 成年患者前瞻性登记数据库的资料进行分析。主要结局为 LOS 的中位数。次要结局为 30 天再入院率、存活率以及大出血和小出血的发生率。共纳入 307 例急性 PE 门诊患者，其中 88 例 (28.7%) 为低危，213 例 (69.4%) 为中危，6 例 (2.0%) 为高危。226 例 (73.6%) 患者接受了 DOAC 治疗。所有接受 DOAC 治疗的患者的 LOS 中位数均显著缩短 (2.9 天，IQR 1.8-4.7 vs 非 DOAC 组 4.9 天，IQR 3-8.9；广义线性模型，p<0.001)。中危患者中，DOAC 组 (3.6 天，IQR 2-5.8) 与非 DOAC 组 (5 天，IQR 3-9) 的 LOS 中位数均缩短，但无统计学差异。两组患者的 30 天再入院率、存活率和出血并发症发生率无差异。DOAC 治疗低危和中危患者可降低 LOS，且 30 天安全性和疗效无差异。与常规抗凝相比，DOAC 治疗急性 PE 患者，尤其是中危患者，可能有助于提前出院，从而降低住院费用。
