Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Clin Transl Sci. 2023 Jun;16(6):946-954. doi: 10.1111/cts.13510. Epub 2023 Mar 23.
The comparative effectiveness and safety of oral anticoagulant therapies to prevent a second recurrent venous thromboembolism (VTE) remains undetermined. We aimed to compare the benefits and harms of direct oral anticoagulant (DOAC) and warfarin therapies in preventing second recurrent VTE and major bleeding events among patients with a recurrent VTE episode following anticoagulation therapy for incident VTE. A retrospective cohort analysis of two large national insurance claims databases was conducted for patients with two episodes of VTE. Cox proportional hazards models were used after inverse probability treatment weighting to compare risks of second recurrent VTE and major bleeding events. Compared with warfarin, DOAC therapy was associated with significantly decreased risk of second recurrent VTE with no significant difference in risk of major bleeding events. Our findings suggest that, compared with warfarin, DOACs may reduce risk of second VTE recurrence among patients who have experienced one recurrence.
口服抗凝药物治疗预防第二次复发性静脉血栓栓塞症（VTE）的有效性和安全性仍未确定。我们旨在比较直接口服抗凝剂（DOAC）和华法林治疗在预防复发性 VTE 患者抗凝治疗后复发的第二次复发性 VTE 和大出血事件方面的益处和危害。对两个大型国家保险索赔数据库中的两次 VTE 发作的患者进行了回顾性队列分析。采用逆概率治疗加权后 Cox 比例风险模型比较第二次复发性 VTE 和大出血事件的风险。与华法林相比，DOAC 治疗与第二次复发性 VTE 的风险显著降低相关，而大出血事件的风险无显著差异。我们的研究结果表明，与华法林相比，DOAC 可能降低经历过一次复发的患者的第二次 VTE 复发风险。
