Ayalon-Dangur Irit, Vega Yakov, Israel Miriam Rozi, Grossman Alon, Spectre Galia, Shochat Tzippy, Leibovici Leonard, Gafter-Gvili Anat
Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
J Clin Med. 2021 Dec 1;10(23):5673. doi: 10.3390/jcm10235673.
Randomized controlled trials that compared direct oral anticoagulants (DOACs) to vitamin K antagonists (VKA) for the treatment of venous thromboembolism (VTE), demonstrated both efficacy and safety of DOACs. The aim of the current study was to compare DOACs to VKA for the treatment of VTE in the elderly, in a real-life setting.
A retrospective cohort study was performed in Rabin Medical Center encompassing a 7-year period. Hospitalized patients >65 years, with a diagnosis of VTE discharged with DOACs or VKA were included. The primary outcome was a composite of all-cause mortality, major bleeding, recurrent VTEs and hospitalizations throughout the follow-up period of one year.
A total of 603 patients were included in the final analysis. The mean age was 79.6 ± 8.5 years. The primary composite outcome occurred in 74.6% and 56.7% of the patients in the VKA group and DOACs group, respectively, hazard ratio 0.59, 95% confidence interval 0.46 to 0.76, in favor of the DOACs group. In a matched cohort analysis, the results were the same as the original analysis.
In the elderly population, treatment of VTE with DOACs was associated with a lower rate of the composite outcome. DOACs are safe and effective for elderly patients with VTE.
比较直接口服抗凝剂（DOACs）与维生素K拮抗剂（VKA）治疗静脉血栓栓塞症（VTE）的随机对照试验，证实了DOACs的有效性和安全性。本研究的目的是在现实生活环境中比较DOACs与VKA治疗老年患者VTE的效果。
在拉宾医疗中心进行了一项为期7年的回顾性队列研究。纳入年龄>65岁、诊断为VTE且出院时使用DOACs或VKA的住院患者。主要结局是在一年的随访期内全因死亡率、大出血、复发性VTE和住院的综合情况。
共有603例患者纳入最终分析。平均年龄为79.6±8.5岁。VKA组和DOACs组患者的主要综合结局发生率分别为74.6%和56.7%，风险比为0.59，95%置信区间为0.46至0.76，DOACs组更优。在匹配队列分析中，结果与原始分析相同。
在老年人群中，使用DOACs治疗VTE与较低的综合结局发生率相关。DOACs对老年VTE患者安全有效。
