Effectiveness and Safety of New Oral Anticoagulants for the Treatment of Symptomatic Venous Thromboembolism:a Single Center, Retrospective Cohort Study in Taiwan

• Main Authors: Kuan-YuChou, 周冠玗
• Other Authors: Ching-Lan Cheng
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/m9t8vd

碩士 === 國立成功大學 === 臨床藥學與藥物科技研究所 === 106 === New oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for management of venous thromboembolism (VTE). The phase Ⅲ trials showed similar rates of recurrent VTE and similar or less rates of major bleeding with NOACs treatment compared with standard anticoagulation (low molecular-weight heparin, overlapping with and followed by a dose-adjusted vitamin K antagonist) for the treatment of VTE. However, subgroup analysis of Asians in phase Ⅲ trials and cohort study enrolling Asians were limited. This study was initiated due to lack of NOACs use in the Taiwanese VTE population. We conducted a retrospective cohort study to assess the effectiveness and safety of NOACs for the treatment of VTE, by chart review in the National Cheng Kung University Hospital. Between January 1, 2014, and April 30, 2017, 382 patients were enrolled in cardiovascular surgery and internal medicine divisions. Compared to Warfarin group, fewer patients in the NOACs group had active cancer or index creatinine clearance (CrCl) less than 30 ml/min. In the propensity score-adjusted population, the frequency of major bleeding was 4.59% (5/109) in the NOACs group and 10.09% (11/109) in the Warfarin group, with a hazard ratio (HR) of 0.967 (95% CI 0.060-15.460; P= 0.9811). The frequency of recurrent VTE was 0.92% (1/109) in the NOACs group and 0.92% (1/109) in the Warfarin group (HR: 0.443; 95% CI 0.154-1.279; P= 0.1323). The frequency of all-cause mortality was 2.75% (3/109) in the NOACs group and 8.26% (9/109) in the Warfarin group (HR: 0.300; 95% CI 0.081-1.107; P= 0.07070). Propensity score-adjusted results confirm that NOACs is a safe and effective alternative to Warfarin. More large-scale studies are warranted to confirm the results due to the limited sample size of this study.