初始静脉外治疗后直接口服抗凝剂引入剂量会影响急性静脉血栓栓塞的临床结果吗?回顾性队列研究。

IF 3.2 4区 医学 Q2 PHARMACOLOGY & PHARMACY
James Kim, Kiyan Heybati, Emily Thompson, Somanshu Sharma, Drew Barron, Hannah Reynolds, Maryann Mirzakandov, Kate Norville, Jenna Reynolds, Harn J Shiue
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引用次数: 0

摘要

简介:静脉血栓栓塞(VTE)治疗的直接口服抗凝剂(DOAC)的起始通常包括一个引入给药阶段。然而,一些患者可能由于合并症和/或大量的肠外治疗而缩短疗程。关于缩短引入治疗方案的结果的数据有限。目的:探讨静脉血栓栓塞(VTE)患者在静脉外抗凝治疗后接受缩短与标准/非缩短DOAC导入方案的临床结果。方法:我们进行了一项回顾性队列研究,纳入了2019年4月1日至2023年12月31日期间因急性静脉血栓栓塞(VTE)入院的成人(≥18岁),接受了≥24小时的肠外抗凝治疗,然后转至DOAC,缩短与非缩短DOAC引入剂量。主要结局是出院后30天内因血栓事件死亡或再入院。数据采用描述性统计、逻辑回归和事件时间分析。结果:590例患者中位(IQR)年龄为67(58-76)岁,其中280例(47.5%)为女性。超过一半的患者有肺栓塞(54.9%,N = 324), 21.0% (N = 124)有深静脉血栓形成,其余患者有合并。大多数患者接受了非缩短引入剂量(83.2%;N = 491)。与非缩短队列相比,接受缩短导入治疗的患者先前有静脉血栓栓塞和心力衰竭的比例更高。缩短引入剂量与主要结局之间没有显著关联(aOR 0.44; 95% CI 0.13-1.52; P = 0.20)。在最长随访时间(3.0%,N = 3 vs. 2.9%, N = 14; P = 0.92; aOR 0.82; 95% CI 0.22-3.1; P = 0.77)和DOAC开始后30天内(HR 1.24; 95% CI 0.26-5.82; P = 0.79),缩短剂量组和非缩短剂量组的出血事件也相似。结论:缩短DOAC导入治疗与短期死亡率、复发血栓再入院或出血无关。需要进一步的前瞻性研究来证实这些发现,并为更个性化的治疗方案提供见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does direct oral anticoagulant lead-in dosing following initial parenteral therapy affect clinical outcomes in acute venous thromboembolism?: A retrospective cohort study.

Introduction: Initiation of direct oral anticoagulants (DOAC) for the management of venous thromboembolism (VTE) typically includes a lead-in dosing phase. However, some patients may receive a shortened course due to comorbid conditions and/or numerous days of parenteral therapy. Limited data exist on the outcomes of an abbreviated lead-in therapy regimen.

Aim: To investigate the clinical outcomes of patients receiving abbreviated versus standard/non-abbreviated DOAC lead-in regimens following parenteral anticoagulation therapy for VTE.

Method: We conducted a retrospective cohort study including adults (≥ 18 years of age) who were admitted for acute VTE between 04/01/2019 and 12/31/2023 and received ≥ 24 h of parenteral anticoagulation before being transitioned to a DOAC with abbreviated versus non-abbreviated DOAC lead-in dose. The primary outcome was death or readmission from a thrombotic event within 30 days of discharge. Data were presented using descriptive statistics, logistic regression, and time-to-event analysis.

Results: Across 590 patients, the median (IQR) age was 67 (58-76) years and 280 (47.5%) were female. Over half had a pulmonary embolism (54.9%; N = 324), 21.0% (N = 124) had a deep vein thrombosis, and the remainder experienced a combination. Most patients received the non-abbreviated lead-in dose (83.2%; N = 491). When compared to the non-abbreviated cohort, a higher proportion of those who received an abbreviated lead-in therapy had prior VTE and heart failure. There were no significant associations between an abbreviated lead-in dose and the primary outcome (aOR 0.44; 95% CI 0.13-1.52; P = 0.20). Bleeding events were also similar between the abbreviated and non-abbreviated dose cohorts at the longest follow-up (3.0%, N = 3 vs. 2.9%, N = 14; P = 0.92; aOR 0.82; 95% CI 0.22-3.1; P = 0.77) and within 30 days of DOAC initiation (HR 1.24; 95% CI 0.26-5.82; P = 0.79).

Conclusion: An abbreviated DOAC lead-in therapy was not associated with short-term mortality, readmission due to recurrent thrombosis, or bleeding. Further prospective studies are needed to confirm these findings and provide insights into more personalized regimens.

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来源期刊
CiteScore
4.10
自引率
8.30%
发文量
131
审稿时长
4-8 weeks
期刊介绍: The International Journal of Clinical Pharmacy (IJCP) offers a platform for articles on research in Clinical Pharmacy, Pharmaceutical Care and related practice-oriented subjects in the pharmaceutical sciences. IJCP is a bi-monthly, international, peer-reviewed journal that publishes original research data, new ideas and discussions on pharmacotherapy and outcome research, clinical pharmacy, pharmacoepidemiology, pharmacoeconomics, the clinical use of medicines, medical devices and laboratory tests, information on medicines and medical devices information, pharmacy services research, medication management, other clinical aspects of pharmacy. IJCP publishes original Research articles, Review articles , Short research reports, Commentaries, book reviews, and Letters to the Editor. International Journal of Clinical Pharmacy is affiliated with the European Society of Clinical Pharmacy (ESCP). ESCP promotes practice and research in Clinical Pharmacy, especially in Europe. The general aim of the society is to advance education, practice and research in Clinical Pharmacy . Until 2010 the journal was called Pharmacy World & Science.
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