指南指导的药物依从性被认为是心脏手术后的重要质量指标。我们评估了使用生物假体进行主动脉瓣置换术(sAVR)后使用华法林的美国心脏病学会/美国心脏协会指南的依从性,并检查了抗凝实践随时间的潜在变化。
使用OptumLabs数据仓库,我们调查了有或没有冠状动脉搭桥的生物假体sAVR的成年患者(2007-2019).术后早期华法林使用定义为sAVR后≥30天连续处方覆盖。
在10730名患有sAVR的成年患者中,3071(28.6%)术后早期接受华法林治疗。华法林处方覆盖率的中位数为4.5个月(四分位数间距,3.0-8.9个月)。然而,只有11.1%(736/6634)的华法林处方覆盖率为3~6个月,符合最新指南.在13年期间,每年的华法林处方率没有显着变化(P=0.386)。与非华法林组患者相比,接受华法林处方的人年龄较大,更可能是男性,并且患有心房颤动,充血性心力衰竭,慢性肺病,和CHA2DS2-VASc评分≥2;接受其他心脏药物处方的患者使用华法林也更多(P<0.05)。
华法林处方反映的sAVR后抗凝治疗可能未得到充分利用;华法林的使用率在过去十年中没有变化。虽然需要更多的研究来证实sAVR后早期抗凝的益处,这些结果表明,大多数临床医生并未遵循指南建议.这些发现突出了质量改进的潜在重要领域。
Guideline-directed medication adherence is considered an important quality measure after cardiac surgery. We evaluated compliance with the American College of Cardiology/American Heart Association
guidelines for warfarin use after surgical aortic valve replacement (sAVR) using bioprostheses and examined potential variations in anticoagulation practice over time.
Using the OptumLabs Data Warehouse, we investigated adult patients having bioprosthetic sAVR with or without coronary artery bypass (2007-2019). Early postoperative warfarin use was defined as ≥30 days of continuous prescription coverage after sAVR.
Among 10 730 adult patients having sAVR, 3071 (28.6%) received warfarin early postoperatively. Median length of warfarin prescription coverage was 4.5 months (interquartile range, 3.0-8.9 months). However, only 11.1% (736/6634) had warfarin prescription coverage of 3 to 6 months in compliance with the most recent
guidelines. Yearly warfarin prescription rate did not change significantly during the 13-year period (P = .386). Compared with patients from the non-warfarin group, those receiving warfarin prescriptions were older and more likely to be male and to have atrial fibrillation, congestive heart failure, chronic pulmonary disease, and CHA2DS2-VASc score ≥2; warfarin use was also greater in patients receiving prescriptions for other cardiac medications (P < .05).
Anticoagulation after sAVR as reflected by warfarin prescriptions may be underused; the rates of warfarin use have not changed in the last decade. Although additional studies are needed to confirm the benefit of early anticoagulation after sAVR, these results indicate that
guideline recommendations are not followed by most clinicians. The findings highlight a potentially important area for quality improvement.