Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104-4865, United States; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106700. doi: 10.1016/j.jstrokecerebrovasdis.2022.106700. Epub 2022 Aug 12.
Stroke is an independent risk factor for venous thromboembolism (VTE). Although the risk of VTE persists after hospital discharge, information on the utilization of anticoagulants among stroke patients after discharge remains limited.
To evaluate changes in post-discharge thromboprophylaxis among stroke patients between 2006 and 2019.
We conducted a retrospective repeated cross-sectional analysis using a commercial healthcare insurance database in the United States. We included patients aged ≥ 18 years with incident stroke diagnosis and assessed prophylactic use of anticoagulants in the 30 days following hospital discharge including low-molecular-weight heparin (enoxaparin ≤40 mg/day, dalteparin ≤5000 IU/day), unfractionated heparin ≤5000 IU/ twice daily or 3 times a day, apixaban 2.5 mg twice daily, and rivaroxaban 10 mg/day. Patients with atrial fibrillation, VTE, mechanical heart valves, cancer, antiphospholipid antibody syndrome, and users of therapeutic doses of anticoagulants were excluded. We used the Cochrane-Armitage test to assess changes in the use of anticoagulants across the study period.
There was a small increase in the overall use of post-discharge prophylactic anticoagulants among stroke patients between 2006 and 2019 from 0.5% to 1.9%. The use of heparin decreased from 0.5% in 2006 to 0.3% in 2019 (P-value for trend = 0.001). In contrast, the use of apixaban or rivaroxaban increased from 0.1% in 2013 to 1.6% in 2019 (P-value for trend < 0.001). Apixaban was more commonly used than rivaroxaban.
In this population-based study of stroke patients, we found that post-discharge anticoagulant use remains low through 2019. Prophylactic use of heparin or rivaroxaban was relatively low but the use of apixaban increased over the study period. Further research is needed to determine if these agents are safe and effective for VTE prevention in stroke patients.
中风是静脉血栓栓塞症（VTE）的独立危险因素。尽管中风患者出院后仍存在 VTE 风险，但关于出院后中风患者使用抗凝剂的信息仍然有限。
评估 2006 年至 2019 年中风患者出院后血栓预防措施的变化。
我们使用美国一家商业医疗保险数据库进行了回顾性重复横断面分析。我们纳入了年龄≥18 岁、有中风初诊的患者，并评估了出院后 30 天内预防性使用抗凝剂的情况，包括低分子肝素（依诺肝素≤40mg/天，达肝素≤5000IU/天）、普通肝素≤5000IU/每天两次或每天三次、阿哌沙班 2.5mg 每天两次和利伐沙班 10mg/天。排除有房颤、VTE、机械心脏瓣膜、癌症、抗磷脂抗体综合征和使用治疗剂量抗凝剂的患者。我们使用 Cochrane-Armitage 检验评估研究期间抗凝剂使用的变化。
2006 年至 2019 年，中风患者出院后预防性使用抗凝剂的总体比例从 0.5%增加到 1.9%，略有增加。肝素的使用从 2006 年的 0.5%下降到 2019 年的 0.3%（趋势检验 P 值=0.001）。相比之下，阿哌沙班或利伐沙班的使用从 2013 年的 0.1%增加到 2019 年的 1.6%（趋势检验 P 值<0.001）。阿哌沙班的使用比利伐沙班更为常见。
在这项基于人群的中风患者研究中，我们发现 2019 年出院后抗凝剂的使用仍然较低。肝素或利伐沙班的预防性使用相对较低，但阿哌沙班的使用在研究期间有所增加。需要进一步研究以确定这些药物是否安全有效，能否用于预防中风患者的 VTE。
