抗凝剂在患有癌症相关血栓症的患者中的比较有效性
Irbaz Bin Riaz1, Harry Fuentes2, Yihong Deng3
1Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona.
JAMA network open
|July 24, 2023
概括
与LMWH和华法林相比,直接口服抗凝剂 (DOACs) 在癌症相关血栓症 (CAT) 患者中显示了较低的VTE复发,出血和死亡风险. 在临床实践中,抗凝剂使用持续时间特别短.
科学领域:
- 在瘤学瘤学.
- 血液学 血液学 血液学
- 药理学 药理学是指药理学的学科.
背景情况:
- 癌症相关血栓形成症 (CAT) 管理和抗凝剂的比较有效性尚未得到研究.
- 了解现实世界的使用模式对于优化患者护理至关重要.
研究的目的:
- 分析活跃癌症和静脉血栓栓塞 (VTE) 患者的抗凝剂处方模式.
- 在这个人群中比较直接口服抗凝剂 (DOAC),低分子量肝素 (LMWH) 和华法林的有效性和安全性.
主要方法:
- 使用非识别电子健康记录索赔数据 (2012-2019) 的回顾性队列研究.
- 包括原发性癌症诊断和静脉瘤发作事件的成年患者.
- 在接受DOAC,LMWH或华法林的患者中比较结果 (VTE复发,主要出血,全因死亡率).
主要成果:
- 总共分析了5100名患者,49.3%接受了DOACs,29.2%的LMWH和28.6%的华法林.
- 与DOAC相比,LMWH和华法林与VTE复发的风险增加有关.
- 与DOACs相比,LMWH显示出较高的重大出血和全因死亡风险.
结论:
- 在临床实践中,CAT患者在短时间内接受抗凝药治疗.
- DOAC与VTE复发,严重出血和死亡率的风险明显降低.
- 华法林仍然是DOAC禁忌或LMWH坚持不良的患者的选择.
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