Cohen Alexander, Sah Janvi, Lee Theodore, Rosenblatt Lisa, Hlavacek Patrick, Emir Birol, Keshishian Allison, Yuce Huseyin, Luo Xuemei
Department of Hematological Medicine, Guy's & St Thomas' NHS Foundation Trust, King's College London, Westminster Bridge Road, London SE1 7EH, UK.
STATinMED Research, Ann Arbor, MI 48108, USA.
J Clin Med. 2021 Jan 8;10(2):200. doi: 10.3390/jcm10020200.
This study integrated 5 United States healthcare claims databases to evaluate the risk of recurrent venous thromboembolism (VTE) and major bleeding (MB) among VTE patients who initiated apixaban vs. warfarin, stratified by obesity. Obese and morbidly obese patients were identified based on diagnosis codes. Stabilized inverse probability treatment weighting (IPTW) was conducted to balance observed patient characteristics between treatment cohorts. An interaction analysis was conducted to evaluate treatment effects of apixaban vs. warfarin according to obesity status. Cox proportional hazard models were used to evaluate the risk of recurrent VTE and MB among IPTW weighted obese and morbidly obese patients. A total of 112,024 non-obese patients and 43,095 obese patients were identified, of whom 19,751 were morbidly obese. When stratified by obesity status post-IPTW, no significant interactions were observed for effects of apixaban vs. warfarin on recurrent VTE or MB (interaction > 0.10). Among IPTW obese and morbidly obese patients, apixaban was associated with a significantly lower risk of recurrent VTE (obese: 0.73 [0.64-0.84]; morbidly obese: 0.65 [0.53-0.80]) and MB (obese: 0.73 [0.62-0.85]; morbidly obese: 0.68 [0.54-0.86]) as compared with warfarin. In this large sample of obese and morbidly obese VTE patients, apixaban had a significantly lower risk of recurrent VTE and MB vs. warfarin.
本研究整合了5个美国医疗保健理赔数据库，以评估起始阿哌沙班与华法林治疗的静脉血栓栓塞症（VTE）患者中复发性VTE和大出血（MB）的风险，并按肥胖情况进行分层。根据诊断编码识别肥胖和病态肥胖患者。采用稳定的逆概率治疗权重法（IPTW）来平衡治疗队列之间观察到的患者特征。进行交互分析以评估阿哌沙班与华法林根据肥胖状态的治疗效果。使用Cox比例风险模型评估IPTW加权的肥胖和病态肥胖患者中复发性VTE和MB的风险。共识别出112,024名非肥胖患者和43,095名肥胖患者，其中19,751名为病态肥胖患者。IPTW后按肥胖状态分层时，未观察到阿哌沙班与华法林对复发性VTE或MB的影响存在显著交互作用（交互作用>0.10）。在IPTW肥胖和病态肥胖患者中，与华法林相比，阿哌沙班与复发性VTE（肥胖：0.73 [0.64 - 0.84]；病态肥胖：0.65 [0.53 - 0.80]）和MB（肥胖：0.73 [0.62 - 0.85]；病态肥胖：0.68 [0.54 - 0.86]）的风险显著降低相关。在这一大量肥胖和病态肥胖VTE患者样本中，与华法林相比，阿哌沙班复发性VTE和MB的风险显著更低。
