第一次未引起的静脉血栓栓塞瘤的无限期抗凝固疗法:一个成本效益研究
Faizan Khan1, Doug Coyle2, Kednapa Thavorn3
1O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (F.K.).
Annals of internal medicine
|June 26, 2023
概括
对未引起的静脉血栓炎的无限期抗凝药可以预防复发事件,但会增加严重出血和成本. 共享决策对于静脉血栓栓塞 (VTE) 患者的治疗持续时间至关重要.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 卫生经济学 卫生经济学
背景情况:
- 临床指南建议在第一次未引起的静脉血栓栓塞 (VTE) 时使用无限期的抗凝药.
- 估计延长抗凝剂的益处危害平衡对于患者管理至关重要.
研究的目的:
- 估计无限期抗凝药与第一次未引起VTE的初始治疗后停止治疗的益处危害权衡.
- 为了为临床决策提供有关抗凝治疗最佳持续时间的信息.
主要方法:
- 进行了马尔科夫建模研究.
- 数据来源于系统性审查,元分析和有关静脉瘤风险,出血事件,成本和生活质量的出版文献.
- 分析的重点是患者首次未引起的VTE完成3-6个月的初始治疗,与终身时间地平线.
主要成果:
- 不确定的抗凝剂预防了每1000名患者中368例复发性VTE事件,但导致了114例额外的重大出血事件.
- 其中包括14例致命的肺栓塞,30例内出血和11例引起的出血死亡.
- 扩展的抗凝血治疗带来了更高的成本 (每人加拿大16014加元),但没有改善质量调整后寿命年 (QALY).
结论:
- 对于未引起的VTE,无限期抗凝药具有复杂的益处-危害权衡.
- 模型灵敏度分析强调了主要出血率和病例死亡率的关键影响.
- 在确定未引起的VTE的抗凝固持续时间时,包括患者偏好在内的共享决策至关重要.
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