心房颤动患者直接口服抗凝剂的处方及转换模式

Prescription and switching patterns of direct oral anticoagulants in patients with atrial fibrillation.

作者信息

de Vries Tim A C, Bavalia Roisin, Chu Gordon, Xiong Helen, van de Wiel Kayleigh M, van Ballegooijen Hanne, Huisman Menno V, Hemels Martin E W, Middeldorp Saskia, de Groot Joris R

机构信息

Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands.

Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

出版信息

Res Pract Thromb Haemost. 2024 Aug 9;8(6):102544. doi: 10.1016/j.rpth.2024.102544. eCollection 2024 Aug.

DOI:10.1016/j.rpth.2024.102544

PMID:39286604

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11404132/

Abstract

BACKGROUND

The patterns of direct oral anticoagulant (DOAC) selection and switching to a different oral anticoagulant (OAC) in patients with atrial fibrillation (AF) are unknown.

OBJECTIVES

To describe temporal patterns in first DOAC prescriptions, estimate the incidence, and identify predictors of switching to a different OAC within 1 year in OAC-naive AF patients.

METHODS

In this retrospective cohort study, using a near-nationwide prescription registry (IQVIA, the Netherlands), we determined the number of patients per month initiated on each DOAC and identified predictors of switching within 1 year with robust Poisson regression.

RESULTS

We included 94,874 patients. From November 2015 to November 2019, the monthly use of apixaban ( = 366 to = 1066, +191%), rivaroxaban ( = 379 to = 868, +129%), and edoxaban ( = 2 to = 305, +15,150%) increased, whereas that of dabigatran decreased ( = 317 to = 179, -44%). In the 66,090 patients with ≥1 year of available calendar time, 7% switched to a different OAC within 1 year. Strong predictors of switching to a different DOAC were using dabigatran (adjusted risk ratio [aRR], 3.33; 95% CI, 3.02-3.66) or edoxaban (aRR, 1.56; 95% CI, 1.34-1.82) rather than apixaban and using a standard DOAC dose (aRR, 2.54; 95% CI, 2.23-2.88). Strong predictors of switching to a vitamin K antagonist were using rivaroxaban (aRR, 1.36; 95% CI, 1.19-1.54 vs apixaban) and using a standard DOAC dose (aRR, 1.49; 95% CI, 1.26-1.77).

CONCLUSION

In the Netherlands, factor Xa inhibitors are increasingly being selected for OAC-naive AF patients. Seven percent of patients switch to a different OAC within 1 year, and the initial DOAC type and dose are strong predictors of switching.

摘要

背景

心房颤动（AF）患者中直接口服抗凝剂（DOAC）的选择模式以及换用另一种口服抗凝剂（OAC）的情况尚不清楚。

目的

描述首次使用DOAC处方的时间模式，估计发生率，并确定初治AF患者在1年内换用另一种OAC的预测因素。

方法

在这项回顾性队列研究中，我们使用近乎全国范围的处方登记系统（荷兰IQVIA公司），确定每月开始使用每种DOAC的患者数量，并通过稳健泊松回归确定1年内换药的预测因素。

结果

我们纳入了94,874例患者。2015年11月至2019年11月，阿哌沙班（从 = 366增至 = 1066，增长191%）、利伐沙班（从 = 379增至 = 868，增长129%）和依度沙班（从 = 2增至 = 305，增长15150%）的月使用量增加，而达比加群的月使用量减少（从 = 317减至 = 179，减少44%）。在有≥1年可用日历时间的66,090例患者中，7%在1年内换用了另一种OAC。换用不同DOAC的强烈预测因素是使用达比加群（调整风险比[aRR]，3.33；95%置信区间[CI]，3.02 - 3.66）或依度沙班（aRR，1.56；95% CI，1.34 - 1.82）而非阿哌沙班，以及使用标准DOAC剂量（aRR，2.54；95% CI，2.23 - 2.88）。换用维生素K拮抗剂的强烈预测因素是使用利伐沙班（aRR，1.36；95% CI，1.19 - 1.54，与阿哌沙班相比）和使用标准DOAC剂量（aRR，1.49；95% CI，1.26 - 1.77）。