在心房中启动非维生素K抗体口服抗凝剂时估计中风风险值:马尔科夫决策模型分析
在PubMed上查看摘要
概括
此摘要是机器生成的。直接口服抗凝剂 (DOACs) 对心房的患者具有超过0. 65%的中风风险有益. 随着中风风险的增加,DOAC治疗改善了质量调整寿命 (QALYs),在风险较高的人群中提供了显著的收益.
科学领域
- 心脏病学
- 药理学
- 健康经济学
背景情况
- 在高风险的心房动患者中,抗凝药疗法已被证明有益于预防缺血性中风.
- 抗凝剂在低风险的肌肉前膜炎患者的疗效以及开始服用直接口服抗凝剂 (DOACs) 的门尚不清楚.
研究的目的
- 确定在AF患者中最低的缺血性中风风险值,以证明开始DOAC治疗是合理的.
- 估计DOAC对非抗凝血性中风风险范围内的质量调整寿命 (QALY) 的影响.
主要方法
- 用马尔科夫决策模型在20年内模拟AF患者的DOAC启动.
- 该模型整合了随机试验和观察性研究中关于DOAC对中风,出血,死亡率和生活质量的数据.
主要成果
- 在没有治疗的情况下,每年非抗凝血性缺血性中风风险的临界值为0. 65%.
- 在高于0. 65%的中风风险下,DOAC疗法增加了QALY,在1%,2%和3%的风险下,QALY分别增加了0. 13%,0. 53和1. 00.
- 在0. 4%的中风风险下,DOAC导致每名患者的QALY略有下降.
结论
- 在每年非抗凝血性中风风险超过0. 65%的AF患者中,DOAC疗法在QALY中具有净益.
- 在AF患者中,DOAC的QALY益处与基线较高的缺血性中风风险成比例.
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