新型口服抗凝药和华法林用于治疗非瓣膜性心房颤动的使用趋势变化

Changing trends in the use of novel oral anticoagulants and warfarin for treating non-valvular atrial fibrillation.

作者信息

Birkinshaw Alexander, Fry Christopher H, Fluck David, Sharma Pankaj, Han Thang S

机构信息

Department of Cardiology, Ashford & St Peter's Foundation Trust, Chertsey, UK.

School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.

出版信息

JRSM Cardiovasc Dis. 2020 Mar 29;9:2048004020915406. doi: 10.1177/2048004020915406. eCollection 2020 Jan-Dec.

DOI:10.1177/2048004020915406

PMID:32284860

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7119231/

Abstract

BACKGROUND

Prevention of thromboembolism by novel oral anticoagulants is increasing, whilst use of vitamin K antagonists is on the decline. We assessed changes in the use of these anticoagulants in treating non-valvular atrial fibrillation between 2014 and 2018.

METHODS

One-hundred and sixty-two consecutive patients (95 men, 67 women) with non-valvular atrial fibrillation, mean age 72.3 years (standard deviation = 11.0), underwent cardiac assessment in a single cardiac unit. Use of anticoagulants at the time of investigation was documented: overall 83 (51.2%) patients were prescribed novel oral anticoagulants and 79 (48.8%) warfarin treatment. Trends in treatment rates with either anticoagulant class over time were characterised by calculating the average annual percentage change using a Joinpoint Regression Program 4.7.0.0.

RESULTS

There were diverging trends in anticoagulant treatment from 2014 to 2018 without join points: yearly increase in novel oral anticoagulant treatment (41.9, 45.5, 53.7, 53.1 and 72.7%, average annual percentage change = 16.2%, 95% confidence interval = 5.8% to 27.5%, < 0.001), and decrease in warfarin treatment (57.1, 54.5, 46.3, 46.9 and 27.3%, average annual percentage change = -14.4%, 95% confidence interval = -25.2% to -2.1%, < 0.001).

CONCLUSIONS

Changing trends in treatment with anticoagulants for patients with non-valvular atrial fibrillation observed within less than two years provide important information to healthcare services to estimate future pharmaco-economic costs for such treatments.

摘要

背景

新型口服抗凝药在预防血栓栓塞方面的应用日益增加，而维生素K拮抗剂的使用则呈下降趋势。我们评估了2014年至2018年间这些抗凝药在治疗非瓣膜性心房颤动中的使用变化。

方法

162例连续的非瓣膜性心房颤动患者（95例男性，67例女性），平均年龄72.3岁（标准差=11.0），在单一心脏科接受心脏评估。记录调查时抗凝药的使用情况：总体上，83例（51.2%）患者被处方使用新型口服抗凝药，79例（48.8%）接受华法林治疗。通过使用Joinpoint回归程序4.7.0.0计算平均年变化百分比，来描述随时间推移两种抗凝药类别治疗率的趋势。

结果

2014年至2018年抗凝治疗呈现出无连接点的不同趋势：新型口服抗凝药治疗逐年增加（41.9%、45.5%、53.7%、53.1%和72.7%，平均年变化百分比=16.2%，95%置信区间=5.8%至27.5%，P<0.001），而华法林治疗减少（57.1%、54.5%、46.3%、46.9%和27.3%，平均年变化百分比=-14.4%，95%置信区间=-25.2%至-2.1%，P<0.001）。