"Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, 21079 Dijon, France.
INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, 21000 Dijon, France.
Int J Environ Res Public Health. 2021 Apr 22;18(9):4443. doi: 10.3390/ijerph18094443.
The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than those taking DOACs (87.11 vs. 86.35 years). In the DOAC group, there were more women (51.92% vs. 48.25%) ( = 0.043), less RCD (89.60% vs. 92.73%) ( = 0.002), less VTE (1.80% vs. 6.59%), less severe heart failure (58.09% vs. 67.87%), less severe hypertension (18.22% vs. 23.60%), less severe kidney diseases (1.49% vs. 3.82%), and fewer drugs per prescription (6.15 vs. 6.66) ( < 0.01 for all). The DOAC group were also less likely to be taking angiotensin receptor blockers (10.79% vs. 13.97%), furosemide (40.81% vs. 49.66%) or digoxin (10.32% vs. 13.66%) than the VKA group ( = 0.009, < 0.001, and = 0.005). DOACs were less prescribed than VKAs. Individuals taking VKAs were older and had more severe comorbidities and more drugs per prescription than those taking DOACs.
直接口服抗凝剂 (DOAC) 在治疗房颤和静脉血栓栓塞症 (VTE) 方面的疗效不劣于维生素 K 拮抗剂 (VKA)。在这项横断面研究中，我们比较了服用 DOAC 和 VKA 的老年人。我们纳入了 2017 年 9 月在勃艮第 Mutualité Sociale Agricole 就诊且有医保报销的年龄≥80 岁的门诊患者。比较了 DOAC 组和 VKA 组的人口统计学条件、登记的慢性病 (RCD) 以及处方药物的数量和类型。在纳入的 3190 名患者中，1279 名 (40%)服用 DOAC，1911 名 (60%)服用 VKA。服用 VKA 的患者比服用 DOAC 的患者年龄更大 (87.11 岁比 86.35 岁)。在 DOAC 组中，女性更多 (51.92%比 48.25%) ( = 0.043)，RCD 更少 (89.60%比 92.73%) ( = 0.002)，VTE 更少 (1.80%比 6.59%)，严重心力衰竭更少 (58.09%比 67.87%)，严重高血压更少 (18.22%比 23.60%)，严重肾脏疾病更少 (1.49%比 3.82%)，且每张处方的药物更少 (6.15 比 6.66) (所有 P 值均<0.01)。DOAC 组服用血管紧张素受体阻滞剂 (10.79%比 13.97%)、呋塞米 (40.81%比 49.66%)或地高辛 (10.32%比 13.66%)的可能性也较小 ( = 0.009、<0.001 和 = 0.005)。与 VKA 相比，DOAC 的使用较少。服用 VKA 的患者年龄较大，合并症更严重，每张处方的药物更多。
