Duru Serap, Bahadır Ayşe, Ertürk Arzu
Clinic of Chest Diseases, Ankara Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Clinic of Chest Diseases, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey.
Tuberk Toraks. 2021 Mar;69(1):65-73. doi: 10.5578/tt.20219908.
The use of new oral anticoagulants (NOACs) for the treatment of thromboembolic diseases is becoming more widespread. The present study brings together the opinions and daily routine clinical practices of physicians regarding the use of NOACs in the geriatric age group for the treatment of venous thromboembolic diseases.
The study accessed 274 physicians (197 attending, 70 resident and seven primary care physicians) with various specialties and academic positions through face-to-face interviews or e-mails, and asked them to complete a questionnaire form prepared for NOAC use on a voluntary basis between 1 May and 31 December 2019.
It was found that physicians preferred NOACs mostly for patients contraindicated for the regular use of low-molecular-weight heparins and warfarin (n: 264, 96%), and with an unbalanced INR level (n: 230, 87%). The use of NOACs was found to be higher in the geriatric age group than other anticoagulants due to the easy dose adjustment, the extended monitoring intervals and the low risk of bleeding. Among the physicians, neither the specialty nor a higher number of occupational working years affected the preference for NOACs or other anticoagulants.
Our study has demonstrated that physicians consider NOACs to be a good treatment option in terms of efficacy and reliability for the treatment of thromboembolic diseases in the geriatric age group, who may have treatment compliance difficulties. It was found also that they plan treatment considering the benefit-to-harm ratio and the bleeding-ischemic event balance.
新型口服抗凝药(NOACs)在血栓栓塞性疾病治疗中的应用日益广泛。本研究汇集了医生们对于在老年人群体中使用NOACs治疗静脉血栓栓塞性疾病的观点和日常临床实践经验。
该研究通过面对面访谈或电子邮件联系了274名具有不同专业和学术职位的医生(197名主治医师、70名住院医师和7名初级保健医生),并要求他们在2019年5月1日至12月31日期间自愿填写一份为NOACs使用情况准备的问卷。
发现医生们大多倾向于将NOACs用于常规使用低分子肝素和华法林存在禁忌的患者(n = 264,96%)以及国际标准化比值(INR)水平不均衡的患者(n = 230,87%)。由于剂量调整简便、监测间隔延长以及出血风险低,NOACs在老年人群体中的使用高于其他抗凝药物。在医生中,专业和更多的职业工作年限均未影响对NOACs或其他抗凝药物的偏好。
我们的研究表明,医生们认为就疗效和可靠性而言,NOACs是治疗老年人群体血栓栓塞性疾病的良好选择,而这一群体可能存在治疗依从性困难。还发现他们在制定治疗方案时会考虑利弊比以及出血 - 缺血事件平衡。