背景:在现实世界的初级护理环境中,针对卒中高风险的房颤(AF)患者的抗凝治疗的可用数据有限。
目的:评估抗凝治疗并阐明选择直接口服抗凝药(DOAC)和华法林的相关因素。
方法:这是一项回顾性队列研究,包括大型初级保健门诊患者≥18岁,2021年1月4日至2023年1月4日期间,美国东北部的20个诊所网络。
方法:卒中高危房颤患者的口服抗凝治疗(男性CHA2DS2-VASc评分≥2,女性≥3)。
结果:在3,118例成人房颤和卒中高风险患者中(中位年龄77.90,IQR71.66-84.50岁;男性57.6%),我们发现年龄较大(aOR1.40,p=0.003),BMI较大(25-29.9:aOR1.32,p=0.048;≥30aOR1.42,p=0.010),服用超过5种药物(aOR2.28,p<0.001)更有可能使用口服抗凝剂。在那些参加OAC的人中,将医疗保险作为唯一的保险(AOR0.53,p=0.032),男性(aOR0.69,p=0.011),肾功能较差(aOR为0.80,p=0.021),与DOAC相比,更高的CHA2DS2-VASc评分(aOR0.88,p=0.024)更有可能服用华法林。每天服用超过5种药物(6-10种药物:aOR1.92,p=0.013;≥16:aOR=2.10,p=0.006)的患者更有可能服用抗凝剂,并且可能接受DOAC而不是华法林。
结论:高脑卒中风险的成人房颤患者如果年龄较大,则更有可能使用口服抗凝剂。BMI≥25,或服用超过5种药物。医疗保险作为唯一的保险,男性,肾功能恶化,较高的CHA2DS2-VASc评分是与华法林使用量增加相关的因素,而每天服用超过5种药物的患者更有可能服用DOAC。
BACKGROUND: The available data on anticoagulation therapy in real-world primary care settings for atrial fibrillation (AF) patients at high risk of stroke is limited.
OBJECTIVE: To evaluate anticoagulation therapy and elucidate the factors associated with the selection between direct oral anticoagulants (DOACs) and warfarin.
METHODS: This is a retrospective cohort study that included patients ≥ 18 years old at a large primary care outpatient group, a network of twenty clinics in the northeast United States between January 4, 2021 - January 4, 2023.
METHODS: Oral anticoagulation therapy in AF patients with high risk of stroke (CHA2DS2-VASc score of ≥ 2 in men or ≥ 3 in women).
RESULTS: Among the 3,118 adult patients with AF and high risk of stroke (median age 77.90, IQR 71.66-84.50 years; male 57.6%), we found that older age (aOR 1.40, p = 0.003), greater BMI (25-29.9: aOR 1.32, p = 0.048; ≥ 30 aOR 1.42, p = 0.010), and taking more than five medications (aOR 2.28, p < 0.001) were more likely to be on an oral anticoagulant. Among those taking an OAC, having Medicare as the sole coverage (aOR 0.53, p = 0.032), male gender (aOR 0.69, p = 0.011), worse renal function (aOR 0.80, p = 0.021), and higher CHA2DS2-VASc score (aOR 0.88, p = 0.024) are more likely to be on warfarin than a DOAC. Patients taking more than five medications daily (6-10 medications: aOR 1.92, p = 0.013; ≥ 16: aOR = 2.10, p = 0.006) were more likely to be on an anticoagulant and may receive a DOAC over warfarin.
CONCLUSIONS: AF with high stroke risk adult patients are more likely to be on an oral anticoagulant if they are older, having BMI ≥ 25, or taking more than five medications. Medicare as the sole coverage, male gender, worse renal function, and higher CHA2DS2-VASc scores are factors associated with greater warfarin usage, while patients taking over five daily medications are more likely to be prescribed DOACs.