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Abstract：
BACKGROUND: Venous thromboembolism (VTE) is a widespread and significant cause of morbidity and mortality on a global scale. The primary objective of this cross-sectional study is to examine the impact of anticoagulant therapy on major organ hemorrhage events in patients diagnosed with acute venous thromboembolism (VTE). Specifically, this research compares the effects of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs).
METHODS: This retrospective observational study examined the medical records of 46 patients who had been diagnosed with VTE and were receiving treatment with DOACs or VKAs. The documentation of patient characteristics encompassed demographic information, comorbidities, and treatment particulars. Within 30 days of hospital admission, the incidence of significant organ bleeding events, with an emphasis on gastrointestinal and intracranial hemorrhage, was the primary outcome evaluated.
RESULTS: Overall, 46 patients with VTE who were treated with oral anticoagulation therapy participated in the study. Twenty-four and 22 patients were administered VKAs and DOACs, respectively. The similarity in baseline characteristics between the DOAC and VKA groups ensured that the analyses were well-matched. The examination of bleeding sites unveiled subtle variations, as the DOAC group exhibited a progressive increase in the incidence of intracranial bleeding (12, 55.5%), while the VKA group demonstrated a surge in upper gastrointestinal bleeding (12, 50%) as well. While lacking statistical significance, these observed patterns are consistent with prior research that indicates that DOACs may have a lower risk of catastrophic hemorrhage in comparison to VKAs. The overall in-hospital mortality rate for patients treated with VKA was 33.3% (n=8), while that treated with DOAC was 18.2% (n=4). These differences did not reach statistical significance (P>0.05). In a similar vein, the evaluation of mortality associated with hemorrhage revealed six (25%) in the group receiving VKA and three (13.6%) in the group receiving DOAC; the P value was not statistically significant (P>0.05).
CONCLUSIONS: This study contributes valuable insights into bleeding outcomes associated with anticoagulant therapy for acute VTE. The nuanced differences in bleeding patterns highlight the complexity of anticoagulant selection, emphasizing the importance of considering bleeding site considerations. The comparable mortality rates support existing evidence regarding the favorable safety profile of DOACs.
METHODS: This retrospective observational study examined the medical records of 46 patients who had been diagnosed with VTE and were receiving treatment with DOACs or VKAs. The documentation of patient characteristics encompassed demographic information, comorbidities, and treatment particulars. Within 30 days of hospital admission, the incidence of significant organ bleeding events, with an emphasis on gastrointestinal and intracranial hemorrhage, was the primary outcome evaluated.
RESULTS: Overall, 46 patients with VTE who were treated with oral anticoagulation therapy participated in the study. Twenty-four and 22 patients were administered VKAs and DOACs, respectively. The similarity in baseline characteristics between the DOAC and VKA groups ensured that the analyses were well-matched. The examination of bleeding sites unveiled subtle variations, as the DOAC group exhibited a progressive increase in the incidence of intracranial bleeding (12, 55.5%), while the VKA group demonstrated a surge in upper gastrointestinal bleeding (12, 50%) as well. While lacking statistical significance, these observed patterns are consistent with prior research that indicates that DOACs may have a lower risk of catastrophic hemorrhage in comparison to VKAs. The overall in-hospital mortality rate for patients treated with VKA was 33.3% (n=8), while that treated with DOAC was 18.2% (n=4). These differences did not reach statistical significance (P>0.05). In a similar vein, the evaluation of mortality associated with hemorrhage revealed six (25%) in the group receiving VKA and three (13.6%) in the group receiving DOAC; the P value was not statistically significant (P>0.05).
CONCLUSIONS: This study contributes valuable insights into bleeding outcomes associated with anticoagulant therapy for acute VTE. The nuanced differences in bleeding patterns highlight the complexity of anticoagulant selection, emphasizing the importance of considering bleeding site considerations. The comparable mortality rates support existing evidence regarding the favorable safety profile of DOACs.
摘要：
背景：静脉血栓栓塞症（VTE）是全球范围内发病率和死亡率的广泛且重要的原因。这项横断面研究的主要目的是研究抗凝治疗对诊断为急性静脉血栓栓塞症（VTE）的患者的主要器官出血事件的影响。具体来说,这项研究比较了维生素K拮抗剂（VKAs）和直接口服抗凝剂（DOACs）的作用。
方法：这项回顾性观察性研究检查了46例诊断为VTE并接受DOAC或VKAs治疗的患者的病历。患者特征的文档包括人口统计信息，合并症,和治疗细节。入院后30天内，重大器官出血事件的发生率，重点是胃肠道和颅内出血，是评估的主要结果。
结果：总体而言，46例接受口服抗凝治疗的VTE患者参与了研究。24名和22名患者接受了VKAs和DOAC，分别。DOAC和VKA组之间基线特征的相似性确保了分析的良好匹配。出血部位的检查揭示了微妙的变化，由于DOAC组表现出颅内出血发生率的进行性增加（12，55.5％），而VKA组也显示上消化道出血激增（12，50％）。虽然缺乏统计学意义，这些观察到的模式与之前的研究一致,之前的研究表明,与VKAs相比,DOAC可能具有更低的灾难性出血风险.接受VKA治疗的患者的总体住院死亡率为33.3％（n=8），而用DOAC治疗的比例为18.2%(n=4)。这些差异没有达到统计学意义(P>0.05)。同样，与出血相关的死亡率评估显示，VKA组6例(25%)，DOAC组3例(13.6%)；P值无统计学意义(P>0.05)。
结论：本研究对急性VTE抗凝治疗相关的出血结局提供了有价值的见解。出血模式的细微差别突出了抗凝剂选择的复杂性，强调考虑出血部位因素的重要性。可比的死亡率支持DOAC良好安全性的现有证据。
方法：这项回顾性观察性研究检查了46例诊断为VTE并接受DOAC或VKAs治疗的患者的病历。患者特征的文档包括人口统计信息，合并症,和治疗细节。入院后30天内，重大器官出血事件的发生率，重点是胃肠道和颅内出血，是评估的主要结果。
结果：总体而言，46例接受口服抗凝治疗的VTE患者参与了研究。24名和22名患者接受了VKAs和DOAC，分别。DOAC和VKA组之间基线特征的相似性确保了分析的良好匹配。出血部位的检查揭示了微妙的变化，由于DOAC组表现出颅内出血发生率的进行性增加（12，55.5％），而VKA组也显示上消化道出血激增（12，50％）。虽然缺乏统计学意义，这些观察到的模式与之前的研究一致,之前的研究表明,与VKAs相比,DOAC可能具有更低的灾难性出血风险.接受VKA治疗的患者的总体住院死亡率为33.3％（n=8），而用DOAC治疗的比例为18.2%(n=4)。这些差异没有达到统计学意义(P>0.05)。同样，与出血相关的死亡率评估显示，VKA组6例(25%)，DOAC组3例(13.6%)；P值无统计学意义(P>0.05)。
结论：本研究对急性VTE抗凝治疗相关的出血结局提供了有价值的见解。出血模式的细微差别突出了抗凝剂选择的复杂性，强调考虑出血部位因素的重要性。可比的死亡率支持DOAC良好安全性的现有证据。
