直接口服抗凝管理策略与大脑动成年人临床结果的关联
Catherine G Derington1, Glenn K Goodrich2, Stanley Xu3
1Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles University of Utah School of Medicine, Salt Lake City.
JAMA network open
|July 6, 2023
概括
与常规护理相比,直接口服抗凝剂 (DOAC) 管理服务没有显示出心房患者的改善结果. 药剂师管理的服务和自动化工具对标准治疗没有显著的好处.
科学领域:
- 心脏病学和血栓形成
- 药理学和治疗学 药理学和治疗学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 抗凝管理服务 (AMS),传统上用于华法林,现在包括直接口服抗凝剂 (DOAC).
- 专业的DOAC治疗管理对患者的结果的影响,特别是对心房动 (AF),仍然不清楚.
研究的目的:
- 为了比较三个不同的DOAC护理模型在预防AF患者抗凝相关不良事件的有效性.
- 为了评估常规护理,使用人口管理工具的常规护理和药剂师管理的DOAC治疗的AMS护理的结果.
主要方法:
- 在凯泽永久的三个地区,对44,746名开始服用口服抗凝药 (DOAC或华法林) 的成年AF患者进行了回顾性队列研究.
- 三种DOAC护理模式的比较:常规护理 (UC),UC加人口管理工具 (PMT) 和药剂师管理的AMS护理.
- 治疗权重的逆概率 (IPTW) 用于调整基线差异并比较结果.
主要成果:
- 在平均2年的随访期间,无论是UC加PMT还是AMS护理模式都没有显示出DOAC患者的UC明显优于UC的结果.
- 综合结果的发病率在不同组之间有所不同,而增强护理模型没有统计学上显著的优势.
- 间接和直接的比较显示,通过先进的DOAC管理策略,预防血栓栓塞事件,严重出血或死亡没有显著改善.
结论:
- 这项研究发现,当直接口服抗凝剂通过人口管理工具或药剂师领导的抗凝管理服务进行管理时,与通常护理相比,患者的结果没有显著改善.
- 目前的增强DOAC管理模式可能不会为心房患者提供与标准处方实践相比的明显优势.
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