对于因静脉血栓栓塞而从急诊室出院的患者,提供抗凝药
Pranav Tandon1, Cameron Thompson2, Karen Li3
1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada.
The American journal of emergency medicine
|April 13, 2025
概括
直接口服抗凝剂 (DOAC) 在静脉血栓塞栓症 (VTE) 中越来越受青. 然而,癌症患者在从急诊室出院后更有可能接受低分子量肝素 (LMWH) 而不是DOAC.
科学领域:
- 药理学 药理学是指药理学的学科.
- 内部医学 内部医学
- 紧急医疗 紧急医疗
背景情况:
- 直接口服抗凝剂 (DOAC) 越来越多地取代传统的抗凝剂,如低分子量肝素 (LMWH) 和维生素K对抗剂,用于静脉血栓塞栓症 (VTE) 治疗.
- 了解影响出院时抗凝剂选择的因素对于优化VTE管理至关重要.
研究的目的:
- 在诊断为VTE的患者的急诊部 (ED) 出院时,确定抗凝剂选择的预测因子 (DOAC vs. LMWH).
- 分析在ED管理的VTE患者中DOACs与LMWH的处方模式.
主要方法:
- 在加拿大安大略省的第三级护理ED诊所诊断出深静脉血栓或肺栓塞的成年患者的回顾性图表审查 (2019年1月 - 2021年12月).
- 多变量后勤回归分析以确定DOAC与LMWH处方在释放时的预测因素.
- 共同变量包括年龄,性别,严重出血史,癌症史和先前的抗凝药.
主要成果:
- 总共有239名VTE患者被纳入分析,其中70.7%的患者在DOAC上出院.
- 80岁以上的患者,女性和有癌症病史的患者分别占队列的12.1%,46.4%和29.7%.
- 癌症史是LMWH使用与DOAC相比的显著预测因素 (调整后的几率比率=12.81).
结论:
- 尽管整体趋势有利于对从ED出院的VTE患者的DOAC,但癌症患者主要被处方为LMWH.
- 这一发现与新出现的证据形成鲜明对比,这些证据支持DOAC在大多数VTE癌症患者的疗效和安全性.
- 需要进一步的研究来探索纵向抗凝趋势,并了解癌症患者LMWH偏好的原因.
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