PDF(Pubmed)
Abstract：
Background: Oral anticoagulants (OACs), such as apixaban and warfarin, are indicated for reducing the risk of recurrent venous thromboembolism (VTE) and are often initiated in the hospital. The aim of this study was to evaluate OAC continuity from inpatient to outpatient settings and the risk of recurrent VTE among patients with an initial event. Methods: This retrospective cohort study utilized hospital charge data and medical and prescription claims from 1 July 2016 to 31 December 2022 to identify adults treated with apixaban or warfarin while hospitalized for VTE. Patients were followed to assess switching or discontinuation post-discharge and the risk of recurrent VTE. The index date was the date of the first apixaban or warfarin claim within 30 days post-discharge. Results: Of the 19,303 eligible patients hospitalized with VTE, 85% (n = 16,401) were treated with apixaban and 15% (n = 2902) received warfarin. After discharge, approximately 70% had ≥1 fill for their respective apixaban or warfarin therapy. The cumulative incidence of discontinuation over the 6 months following index was 50.5% and 52.2% for the apixaban and warfarin cohorts, respectively; the cumulative incidence of switching was 6.0% and 20.9%, respectively. The incidence rates of recurrent VTE were 1.2 and 2.5 per 100 person-years for the apixaban and warfarin cohorts, respectively. Conclusions: The majority of patients continued their apixaban or warfarin therapy following hospital discharge; however, a considerable proportion either switched or discontinued OAC upon transitioning from inpatient care. Among those who continued therapy, discontinuation, switch, and recurrent VTE occurred less often with apixaban vs. warfarin.
摘要：
背景：口服抗凝剂（OACs），比如阿哌沙班和华法林，用于降低复发性静脉血栓栓塞（VTE）的风险，并且通常在医院开始。这项研究的目的是评估从住院到门诊的OAC连续性以及初始事件患者中复发性VTE的风险。方法：这项回顾性队列研究利用2016年7月1日至2022年12月31日的医院收费数据以及医疗和处方索赔，以确定在因VTE住院期间接受阿哌沙班或华法林治疗的成年人。随访患者以评估出院后的转换或停药以及复发性VTE的风险。索引日期是出院后30天内首次提出阿哌沙班或华法林索赔的日期。结果：在19,303例符合条件的VTE住院患者中，85%(n=16,401)接受阿哌沙班治疗，15%(n=2902)接受华法林治疗。放电后,约70%的患者在各自的阿哌沙班或华法林治疗中出现≥1次填充。阿哌沙班和华法林队列在6个月内停止治疗的累积发生率为50.5%和52.2%。转换的累积发生率分别为6.0%和20.9%，分别。阿哌沙班和华法林队列的复发性VTE发生率分别为1.2和2.5/100人年。分别。结论：大多数患者在出院后继续接受阿哌沙班或华法林治疗；然而，相当比例的人在从住院护理过渡后转换或停止OAC。在那些继续治疗的人中，停药,开关,阿哌沙班与阿哌沙班相比，复发性静脉血栓栓塞的发生率较低华法林.
