心房颤动患者抗凝治疗模式的真实世界评估：来自多中心ROTA研究的数据。
Real-World Evaluation of Anticoagulant Treatment Patterns in Patients with Atrial Fibrillation: Data from Multicenter ROTA Study.
作者信息
Kocabaş Umut, Ergin Işıl, Yavuz Veysel, Murat Selda, Özdemir Ibrahim, Genç Ömer, Altın Cihan, Tüner Haşim, Keskin Meriç Bengisu, Çoner Ali, İlkay Yüce Elif, Boyraz Bedrettin, Aslan Onur, Dal Ahmet, Şen Taner, İbişoğlu Ersin, Erdoğan Aslan, Özgeyik Mehmet, Demir Mevlüt, Bilgel Ziya Gökalp, Güvendi Şengör Büşra, Urgun Örsan Deniz, Doğduş Mustafa, Naki Tekin Deniz Dilan, Çakal Sinem, Çayırlı Sercan, Güler Arda, Karabulut Dilay, Dalgıç Onur, Uzman Osman, Murat Bektaş, Şahin Şeyda, Karabulut Umut, Kıvrak Tarık, Coşgun Muharrem Said, Özyurtlu Ferhat, Kaplan Mehmet, Özçalık Emre
机构信息
Başkent University Izmir Hospital, Department of Cardiology, Izmir, Türkiye.
Ege University, Faculty of Medicine, Department of Public Health, Izmir, Türkiye.
出版信息
Turk Kardiyol Dern Ars. 2023 Mar;51(2):88-96. doi: 10.5543/tkda.2022.98455.
OBJECTIVE
Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation.
METHODS
The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021.
RESULTS
The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2-VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants.
CONCLUSIONS
The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.time in therapeutic range with <70%.
目的
口服抗凝治疗是房颤管理中预防卒中及全身栓塞的基石。然而，关于房颤患者卒中及全身栓塞预防策略的真实世界信息有限。ROTA研究的目的是获取房颤患者抗凝治疗模式的真实世界数据。
方法
ROTA研究是一项前瞻性、多中心观察性研究，纳入了2597例房颤患者。研究人群于2021年1月至2021年5月从41家心脏病门诊招募。
结果
研究人群的中位年龄为72岁（范围：22 - 98岁），女性占57.4%。CHA2DS2 - VASc和HAS - BLED评分的中位数分别为4分（范围：0 - 9分）和1分（范围：0 - 6分）。分别有15.9%和79.4%的患者使用维生素K拮抗剂和直接口服抗凝剂。接受维生素K拮抗剂治疗的患者治疗范围内的平均时间为52.9%，其中76%的患者治疗范围内时间不足，低于70%。最常用的直接口服抗凝剂是利伐沙班（38.1%）、阿哌沙班（25.5%）和依度沙班（11.2%）。卒中风险低的患者中维生素K拮抗剂和直接口服抗凝剂的过度使用率较高（76.1%），超过四分之一接受直接口服抗凝治疗的患者接受的是直接口服抗凝剂的减量治疗。在接受直接口服抗凝治疗的患者中，接受阿哌沙班治疗的患者比接受其他直接口服抗凝剂的患者年龄更大，CHA2DS2 - VASc和HAS - BLED评分更高，肌酐清除率更低。
结论
ROTA研究提供了关于房颤患者抗凝治疗模式的重要真实世界信息。治疗范围内时间低于70%。
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