直接口服抗凝剂治疗严重遗传性血栓患者：来自三级保健中心的真实世界数据

Q4 Medicine

Thrombosis Update Pub Date : 2025-01-31 DOI:10.1016/j.tru.2025.100201

Omri Cohen , Merav Arnon , Irit Birger , Ophira Salomon , Shadan Lalezari , Orly Efros , Tami Barazani Brutman , Gili Kenet , Aaron Lubetsky , Sarina Levy-Mendelovich

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引用次数: 0

摘要

背景：遗传性血栓性疾病（IT）使个体易患静脉血栓栓塞症（VTE），并增加首次发生VTE和复发性VTE的风险。直接口服抗凝剂（DOACs）或维生素K拮抗剂（VKAs）治疗的IT患者的预后仍未得到充分研究。方法回顾性分析在大型三级医疗中心接受DOACs治疗的重症静脉血栓栓塞患者。使用MDClone平台进行数据提取。主要结果是静脉血栓栓塞的复发率和在DOAC或vka治疗期间的大出血。结果共纳入160例IT患者。中位年龄为44.3岁，56.9%为女性。无因性静脉血栓栓塞是最常见的表现，占45.0%的病例，其次是雌激素暴露（21.9%）和其他轻微诱因（16.9%）。82例患者（51.2%）接受doac治疗，78例患者（48.7%）接受维生素Kantagonists （vka）治疗，其中40例患者后来改用doac。在中位5.2年的随访中，静脉血栓栓塞的复发率为12.5%，并伴有较高的Charlson合并症评分。非诱发性静脉血栓栓塞患者复发率最高（20.8%）。在多变量分析中，复发率不受性别、初始静脉血栓栓塞事件的年龄、合并症、血栓形成亚型或抗凝类型的影响。大出血的发生率较低，抗凝治疗组的大出血发生率相似。结论在静脉血栓栓塞复发和出血风险方面，doacs和vka在IT患者中提供了相当的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Direct oral anticoagulants in patients with severe inherited thrombophilia: Real-world data from a tertiary care center

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Direct oral anticoagulants in patients with severe inherited thrombophilia: Real-world data from a tertiary care center

Background

Inherited thrombophilia (IT) predisposes individuals to venous thromboembolism (VTE) and increases the risk for first event VTE as well as for recurrent VTE. Outcomes in patients with IT treated with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), remain mostly underexplored.

Methods

This retrospective study analyzed VTE patients with severe IT treated with DOACs at a large tertiary center. The MDClone platform was used for data extraction. Main outcomes were rates of VTE recurrence and major bleeding while on treatment with either DOAC or VKAs.

Results

A total of 160 patients with IT were included. The median age was 44.3 and 56.9 % were female. Unprovoked VTE was the most common presentation, accounting for 45.0 % of cases, followed by events provoked by estrogen exposure (21.9 %) and other minor triggers (16.9 %). DOACs were exclusively administered in 82 patients (51.2 %), whereas 78 (48.7 %) received vitamin Kantagonists (VKAs), of whom 40 were later switched to DOACs.

Over a median of 5.2 years follow-up, VTE recurrence was observed in 12.5 %, and associated with higher Charlson comorbidity scores. Patients with unprovoked VTE exhibited the highest recurrence rates (20.8 %). In multivariate analysis recurrence rates were unaffected by gender, age at initial VTE event, comorbidity, thrombophilia subtype, or anticoagulant type. Incidence of major bleeding was low and was also similar across anticoagulant groups.