Huang Yen-Min, Shih Hsuan-Jen, Chen Yi-Chan, Hsieh Tsan-Yu, Ou Che-Wei, Su Po-Hsu, Chen Shih-Ming, Zheng Yun-Cong, Hsu Li-Sung
Hemophilia and Thrombosis Treatment Center, Division of Hematology and Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan.
Division of Hematology and Oncology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan 265, Taiwan.
Cancers (Basel). 2023 Mar 26;15(7):1985. doi: 10.3390/cancers15071985.
Pancreatic cancer can induce a hypercoagulable state which may lead to clinically apparent thrombosis. However, the effect of anticoagulants remains ambiguous. This study aimed to investigate the potential effect of long-term systemic anticoagulant usage on hospitalization outcomes of patients with pancreatic cancer. This retrospective study extracted all data from the U.S. Nationwide Inpatient Sample (NIS) database from 2005 to 2018. We included hospitalized adults ≥18 years old with a pancreatic cancer diagnosis identified by International Classification of Diseases ninth revision (ICD-9) and tenth revision (ICD-10) codes. We utilized diagnostic codes ICD9 V58.61 and ICD10 Z79.01, i.e., 'long-term use of anticoagulant', to identify individuals who were on a long-term systemic anticoagulant. The study cohort were then further grouped as being with or without long-term systemic use of an anticoagulant. Propensity score matching was performed to balance the characteristics of the two groups. The risks of life-threatening events, e.g., acute myocardial infarction (AMI), acute heart failure (AHF), sepsis, shock, and acute kidney injury (AKI), in-hospital death, and prolonged length of stay (LOS) in the hospital were compared between the groups by univariable and multivariable logistic regression analyses. The study population consisted of 242,903 hospitalized patients with pancreas cancer, 6.5% ( = 15,719) of whom were on long-term systemic anticoagulants. A multivariable regression analysis showed that long-term systemic anticoagulant use was independently associated with lower odds of sepsis (aOR: 0.81, 95% CI: 0.76-0.85), shock (aOR: 0.59, 95% CI: 0.51-0.68), AKI (aOR: 0.86, 95% CI: 0.81-0.91), in-hospital mortality (aOR: 0.65, 95% CI: 0.60-0.70), and prolonged LOS (aOR: 0.84, 95% CI: 0.80-0.89). Long-term systemic anticoagulant use is associated with better clinical outcomes in terms of decreased risks of some life-threatening events, in-hospital death, and prolonged LOS among hospitalized patients with pancreatic cancer in the U.S.
胰腺癌可引发高凝状态，进而可能导致临床上明显的血栓形成。然而，抗凝剂的效果仍不明确。本研究旨在探讨长期全身性使用抗凝剂对胰腺癌患者住院结局的潜在影响。这项回顾性研究提取了2005年至2018年美国全国住院患者样本（NIS）数据库中的所有数据。我们纳入了年龄≥18岁、经国际疾病分类第九版（ICD - 9）和第十版（ICD - 10）编码确诊为胰腺癌的住院成人患者。我们利用诊断编码ICD9 V58.61和ICD10 Z79.01，即“长期使用抗凝剂”，来识别长期接受全身性抗凝剂治疗的个体。然后，将研究队列进一步分为长期全身性使用抗凝剂组和未使用组。进行倾向得分匹配以平衡两组的特征。通过单变量和多变量逻辑回归分析比较两组中危及生命事件的风险，如急性心肌梗死（AMI）、急性心力衰竭（AHF）、败血症、休克和急性肾损伤（AKI）、住院死亡以及住院时间延长（LOS）的情况。研究人群包括242,903例住院胰腺癌患者，其中6.5%（n = 15,719）长期接受全身性抗凝剂治疗。多变量回归分析显示，长期全身性使用抗凝剂与败血症（调整后比值比：0.81，95%置信区间：0.76 - 0.85）、休克（调整后比值比：0.59，95%置信区间：0.51 - 0.68）、AKI（调整后比值比：0.86，95%置信区间：0.81 - 0.91）、住院死亡率（调整后比值比：0.65，95%置信区间：0.60 - 0.70）及住院时间延长（调整后比值比：0.84，95%置信区间：0.80 - 0.89）的较低几率独立相关。在美国，长期全身性使用抗凝剂与住院胰腺癌患者某些危及生命事件风险降低、住院死亡及住院时间延长方面的更好临床结局相关。
