华法林和直接口服抗凝剂之间的死亡风险:基于人口的队列研究
Zixuan Wang1,2,3, Julian Matthewman4, John Tazare5
1Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology & Population Health, London, School of Hygiene and Tropical Medicine , London, UK. z.wang.11@bham.ac.uk.
BMC medicine
|December 22, 2024
概括
在英国的数据中,华法林使用的死亡风险低于直接口服抗凝剂 (DOAC),但在香港的数据中风险更高. 抗凝血控制显著影响华法林.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 与华法林相比,关于直接口服抗凝剂 (DOAC) 与死亡风险之间的关联存在相互矛盾的报道.
- 之前使用英国初级保健数据的研究表明,DOAC与华法林的死亡风险更高.
- 其他研究对DOAC和华法林的比较死亡风险提出了矛盾的发现.
研究的目的:
- 与DOACs相比,调查华法林与所有原因死亡风险之间的关联.
- 探索抗凝血控制对与华法林相比的死亡风险的影响.
主要方法:
- 使用英国临床实践研究数据链 (CPRD) Aurum和香港CDARS数据库进行了队列研究.
- 包括18岁或以上的非膜动患者,在2011年1月1日至2019年12月31日期间开始华法林或DOAC治疗的个人.
- 为了比较死亡风险,计算了危险比率 (HR) 和95%置信区间 (CI).
主要成果:
- 在英国CPRD中,与DOAC相比,华法林使用与所有原因死亡率的风险较低 (HR=0.81,95%CI=0.77-0.86) 相联系.
- 相反,在香港的CDARS中,华法林使用显示出与DOAC相比,所有原因死亡的风险更高 (HR=1.31,95%CI=1.24-1.39).
- 根据治疗范围 (TTR) 的时间分层的探索性分析表明,与DOAC相比,华法林使用者TTR≥65%的死亡风险较低 (CPRD:HR=0.68;CDARS:HR=0.86) 和TTR<65%的风险增加 (CPRD:HR=1.14;CDARS:HR=1.59).
结论:
- 华法林和DOAC之间的所有原因死亡率观察到的差异可能部分归因于华法林使用者的抗凝血控制.
- 该研究无法确定华法林与与DOAC相比TTR分层的死亡率之间的因果关系.
- 需要进一步的研究来确定因果关系,并了解这些多样化的关联.
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