Department of Graduate Medical Education, 21878Abbott Northwestern Hospital, 5531Allina Health, Minneapolis, MN, USA.
Department of Critical Care, 21878Abbott Northwestern Hospital, 5531Allina Health, Minneapolis, MN, USA.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231156414. doi: 10.1177/10760296231156414.
Direct-acting oral anticoagulants (DOACs) are prescribed in the treatment of venous thromboembolism, including pulmonary embolism (PE). Evidence is limited regarding the outcomes and optimal timing of DOACs in patients with intermediate- or high-risk PE treated with thrombolysis. We conducted a retrospective analysis of outcomes among patients with intermediate- and high-risk PE who received thrombolysis, by choice of long-term anticoagulant agent. Outcomes of interest included hospital length of stay (LOS), intensive care unit LOS, bleeding, stroke, readmission, and mortality. Descriptive statistics were used to examine characteristics and outcomes among patients, by anticoagulation group. Patients receiving a DOAC (n = 53) had shorter hospital LOS compared to those in warfarin (n = 39) and enoxaparin (n = 10) groups (mean LOS 3.6, 6.3 and 4.5 days, respectively; < .0001). This single institution retrospective study suggests DOAC initiation <48 h from thrombolysis may result in shorter hospital LOS compared to DOAC initiation ≥48 h ( < .0001). Further larger studies with more robust research methodology are needed to address this important clinical question.
直接口服抗凝剂（DOACs）用于治疗静脉血栓栓塞症，包括肺栓塞（PE）。溶栓治疗中，对于中高危 PE 患者，使用 DOAC 的结局和最佳时机的证据有限。我们通过选择长期抗凝药物，对接受溶栓治疗的中高危 PE 患者的结局进行了回顾性分析。感兴趣的结局包括住院时间（LOS）、重症监护病房 LOS、出血、卒中和再入院以及死亡率。通过抗凝组，描述性统计方法用于检查患者的特征和结局。与华法林（n = 39）和依诺肝素（n = 10）组相比，接受 DOAC（n = 53）的患者住院 LOS 更短（平均 LOS 分别为 3.6、6.3 和 4.5 天；< 0.0001）。这项单中心回顾性研究表明，与 DOAC 起始时间距溶栓治疗≥48 h 相比，溶栓治疗后<48 h 开始 DOAC 治疗可能导致住院 LOS 更短（< 0.0001）。需要进一步开展更大规模的研究，采用更稳健的研究方法来解决这一重要的临床问题。
