华法林延长治疗的依从性轨迹以及复发性静脉血栓栓塞和大出血的风险。
Trajectories of adherence to extended treatment with warfarin and risks of recurrent venous thromboembolism and major bleeding.
作者信息
Kang Hye-Rim, Jones Bobby L, Lo-Ciganic Wei-Hsuan, DeRemer Christina E, Dietrich Eric A, Huang Pei-Lin, Park Haesuk
机构信息
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA.
出版信息
Res Pract Thromb Haemost. 2023 Mar 27;7(3):100131. doi: 10.1016/j.rpth.2023.100131. eCollection 2023 Mar.
BACKGROUND
Little is published about warfarin therapy adherence patterns beyond 6 months of initial anticoagulant treatment and their association with effectiveness and safety for patients with venous thromboembolism (VTE).
OBJECTIVES
To compare the risks of recurrent VTE and major bleeding during extended treatment between adherence patterns using MarketScan Commercial and Medicare Supplemental databases (2013-2019).
METHODS
In a retrospective cohort study, we included patients with incident VTE who completed an initial 6-month anticoagulant treatment and received either warfarin or no extended therapy. Group-based trajectory models were used to identify distinct extended treatment trajectories. Associations between the trajectories and risk of hospitalization due to recurrent VTE and major bleeding were assessed using inverse probability treatment-weighted Cox proportional hazards models.
RESULTS
Compared with no extended treatment, consistently high warfarin adherence was associated with a significantly decreased risk of hospitalization due to recurrent VTE (hazard ratio [HR] = 0.23; 95% CI, 0.12-0.45), but gradually (HR = 0.29; 95CI, 0.08-1.06) or rapidly declining (HR = 0.14; 95% CI, 0.02-1.24) adherence showed no association with the risk of hospitalization due to recurrent VTE. Compared with no extended treatment, warfarin extended therapy was associated with an increased risk of hospitalization due to major bleeding regardless of adherence patterns (consistently high: HR = 2.08; 95% CI, 1.18-3.64, gradually declining: HR = 2.10; 95% CI, 0.74-5.95, and rapidly declining: HR = 9.19; 95% CI, 4.38-19.29). However, compared with rapidly declining adherence, consistently high (HR = 0.23; 95% CI, 0.11-0.47) and gradually declining (HR = 0.23; 95% CI, 0.08-0.64) adherence were associated with decreased risk of hospitalization due to major bleeding.
CONCLUSION
The findings indicated that consistently high adherence to extended warfarin treatment was associated with a decreased risk of hospitalization due to recurrent VTE but an increased risk of hospitalization due to major bleeding compared with no extended treatment.
背景
关于华法林治疗依从模式在初始抗凝治疗6个月后的情况及其与静脉血栓栓塞症（VTE）患者有效性和安全性的关联，相关发表内容较少。
目的
使用MarketScan商业数据库和医疗保险补充数据库（2013 - 2019年）比较不同依从模式在延长治疗期间复发性VTE和大出血的风险。
方法
在一项回顾性队列研究中，我们纳入了发生VTE且完成初始6个月抗凝治疗并接受华法林或未接受延长治疗的患者。基于组的轨迹模型用于识别不同的延长治疗轨迹。使用逆概率治疗加权Cox比例风险模型评估轨迹与因复发性VTE和大出血导致住院风险之间的关联。
结果
与未进行延长治疗相比，持续高华法林依从性与因复发性VTE导致住院的风险显著降低相关（风险比[HR]=0.23；95%CI，0.12 - 0.45），但逐渐（HR = 0.29；95%CI，0.08 - 1.06）或快速下降（HR = 0.14；95%CI，0.02 - 1.24）的依从性与因复发性VTE导致住院的风险无关联。与未进行延长治疗相比，无论依从模式如何，华法林延长治疗与因大出血导致住院的风险增加相关（持续高：HR = 2.08；95%CI，1.18 - 3.64，逐渐下降：HR = 2.10；95%CI，0.74 - 5.95，快速下降：HR = 9.19；95%CI，4.38 - 19.29）。然而，与快速下降的依从性相比，持续高（HR = 0.23；95%CI，0.11 - 0.47）和逐渐下降（HR = 0.23；95%CI，0.08 - 0.64）的依从性与因大出血导致住院的风险降低相关。
结论
研究结果表明，与未进行延长治疗相比，持续高依从性的华法林延长治疗与因复发性VTE导致住院的风险降低相关，但与因大出血导致住院的风险增加相关。
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