Clinic of Vascular Medicine, HELIOS Klinik Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.
Clinic of Cardiology, HELIOS Klinik Krefeld, Krefeld, Germany.
J Thromb Thrombolysis. 2020 May;49(4):533-539. doi: 10.1007/s11239-020-02061-3.
The aim of the study was to compare nationwide time trends of prescribed oral anticoagulants (OAC) with the time trend of genitourinary bleedings (GUB) in Germany from 2005 through 2016. The annual numbers of hospitalized patients with GUB coded as "hematuria", "excessive, frequent and irregular menstruation", "postmenopausal bleeding" or "abnormal uterine and vaginal bleeding" were extracted from the nationwide hospitalization file by the Federal Bureau of Statistics. Hospitalization rates were age-standardized using the German standard population 2011. Defined daily doses (DDD) of prescribed anticoagulants among outpatients for the same calendar period were extracted from reports of the statutory health insurance drug information system. Based on DDD, drug treatment rates per 100,000 person years (py) were calculated. From 2005 to 2016, annual OAC treatment rates per 100,000 py increased by 135.8% (from 901.4 to 2125.9). Until 2011 direct oral anticoagulants (DOAC) represented less than 0.1% of all OAC, but 49.9% in 2016. In the same period age-standardized rates of hospitalizations for hematuria increased continuously (annual change of 1.03 (95% CI 0.94-1.11) per 100,000 py), that of "postmenopausal" (- 1.93; 95% CI - 2.38 to - 1.49) or "excessive, frequent and irregular menstruation" decreased (- 1.25; 95% CI -1.62 to - 0.87) and that of "abnormal uterine and vaginal haemorrhage" remained almost unchanged. From all cases with hematuria 5.3% received at least 1 red blood cell concentrate (RBC) in 2005 and 8.2% in 2016 whereas all cases with the other three types of bleeding counted for 1.9% in 2005 and 3.8% in 2016. The time trends for GUB in all subgroups changed steadily and showed no effect of the disproportional increase of DAOCs until 2011. Our ecologic nationwide comparison of OAC treatment rates in outpatients and hospitalization rates for GUBs revealed that despite increasing OAC treatment rates from 2011 to 2016 the hospitalization rates for GUB showed steady annual changes unaffected by the increasing prescription rates of DOACs since 2011.
本研究旨在比较德国 2005 年至 2016 年期间，口服抗凝剂 (OAC) 的全国性时间趋势与泌尿生殖系统出血 (GUB) 的时间趋势。从联邦统计局的全国住院档案中提取了编码为“血尿”、“过度、频繁和不规则月经”、“绝经后出血”或“子宫和阴道异常出血”的 GUB 住院患者的年住院人数。使用 2011 年德国标准人口对住院率进行年龄标准化。在同一日历期内，从法定健康保险药物信息系统的报告中提取了门诊患者处方抗凝剂的定义日剂量 (DDD)。根据 DDD，计算了每 10 万人年 (py) 的药物治疗率。从 2005 年到 2016 年，每年每 10 万人 py 的 OAC 治疗率增加了 135.8%（从 901.4 增加到 2125.9）。直到 2011 年，直接口服抗凝剂 (DOAC) 在所有 OAC 中的比例不到 0.1%，但在 2016 年达到了 49.9%。同期，血尿的住院率持续增加（每年每 10 万人 py 增加 1.03（95%CI 0.94-1.11）），“绝经后”（-1.93；95%CI -2.38 至 -1.49）或“过度、频繁和不规则月经”减少（-1.25；95%CI -1.62 至 -0.87），而“子宫和阴道异常出血”几乎保持不变。在所有血尿患者中，2005 年有 5.3%至少接受了 1 个红细胞浓缩物 (RBC)，2016 年有 8.2%；而所有其他三种出血类型的患者在 2005 年占 1.9%，2016 年占 3.8%。所有亚组的 GUB 时间趋势均稳定变化，且在 2011 年之前，直接口服抗凝剂的比例不成比例增加并没有对其产生影响。我们对门诊 OAC 治疗率和 GUB 住院率的全国性生态比较显示，尽管从 2011 年到 2016 年 OAC 的治疗率不断增加，但 GUB 的住院率却呈现出稳定的年度变化，不受 2011 年以来 DOAC 处方率增加的影响。
