真实世界和dexanet α α的使用，以及由于医院转院导致的给药延迟与全因住院死亡率之间的关系

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-01-01 DOI:10.1016/j.rpth.2025.102688

Huiqiao Fan, Youssef Bessada, Craig I. Coleman

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引用次数: 0

摘要

背景：对于逆转Xa因子抑制剂相关出血，andexanet α - fa的贬值作用很小，队列来自单一/有限的地点。由于医院转院而延迟提供抗凝逆转可能导致较差的结果。目的描述阿德沙那特服用者的特点和结果，并评估因从不同的急诊医院转院而延迟给药阿德沙那特与全因住院死亡率之间的关系。方法采用全国住院患者样本资料进行回顾性研究。住院治疗的程序代码为andexanet alfa，计费代码为出血。进行了描述性分析和多变量logistic回归，以估计因从不同的急性护理医院转院而延迟使用andexanet与全因住院患者死亡率之间的比值比和95% CI。结果2019年至2021年，4210名接受阿德沙奈治疗并出血的成年人住院。以颅内出血为主（62.0%）。全因住院死亡率发生率为16.6% (95% CI, 14.3%-19.3%)，平均住院时间为9.1天（95% CI, 8.4-9.8），平均住院费用为73,600美元（95% CI, 65,000- 82,200美元）。在所有病例中，18.5%的患者在接受阿德沙奈前从不同的急性护理医院转院。转院患者的全因住院死亡率增加了82% (95% CI, 17%-183%)，但当人群仅限于颅内出血时，没有达到统计学意义(优势比，1.51；95% ci, 0.88-2.60)。结论医院转院导致的延迟用药可能与全因死亡率增加有关。

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Real-world andexanet alfa utilization and the association between delay in administration due to hospital transfer and all-cause inpatient mortality

Background

Evaluations of andexanet alfa for the reversal of factor Xa inhibitor-associated bleeding have been small, with cohorts drawn from single/limited sites. Delays in providing anticoagulation reversal due to hospital transfer may result in poorer outcomes.

Objectives

To describe the characteristics and outcomes of andexanet alfa users and evaluate the association between delay in andexanet alfa administration due to transfer from a different acute care hospital and the incidence of all-cause inpatient mortality.

Methods

This was a retrospective study using National Inpatient Sample data. Hospitalizations with procedural codes for andexanet alfa and a billing code for bleeding were included. Descriptive analysis was performed, as was multivariable logistic regression, to estimate the odds ratio and 95% CI for the association between andexanet alfa delayed due to transfer from a different acute care hospital and all-cause inpatient mortality.

Results

From 2019 to 2021, 4210 hospitalizations occurred in adults receiving andexanet alfa and a bleed. Most were hospitalized with intracranial hemorrhage (62.0%). The incidence of all-cause inpatient mortality was 16.6% (95% CI, 14.3%-19.3%), mean hospital stays lasted 9.1 days (95% CI, 8.4-9.8), and mean hospital costs were $73,600 (95% CI, $65,000-$82,200). Of all cases, 18.5% were transferred from a different acute care hospital prior to receiving andexanet alfa. Cases with hospital transfer had an 82% increased odds of all-cause inpatient mortality (95% CI, 17%-183%) but did not reach statistical significance when the population was limited to intracranial hemorrhage (odds ratio, 1.51; 95% CI, 0.88-2.60).