To investigate the association of age and other factors with thrombosis risk in antiphospholipid antibody (aPL) carriers, a retrospective observational study was conducted in a cohort of patients with medium-high aPL titres recruited in a tertiary care hospital. Assuming an age difference of 9.8 years between patients with and without thrombosis, we estimated that a sample size of 70 participants was required. Several variables besides age including gender, vascular risk factors, inherited thrombophilias, non-thrombotic clinical manifestations, laboratory parameters, aPL profile, length of aPL exposure, antithrombotic drugs and partial aPL score were assessed by univariate analysis followed by multivariate logistic regression. Outcomes were analysed by whether thromboses occurred before (model 1) or after (model 2) aPL detection. Seventy patients [50 females; median (interquartile range) baseline age: 46.99 (39.39-66.20) years] were followed for 2.59 (0.67-5.86) years. Overall, 18 and 5 thromboses were diagnosed applying models 1 and 2, respectively. Time to thrombosis after aPL detection was 2.10 (1.03-8.24) years. Age did not differ between patients with and without thrombosis using models 1 (p = 0.92) or 2 (p = 0.67). Instead, we identified other predictors of thrombosis, namely, lack of thromboprophylaxis [odds ratio (OR) 13.50, 95% confidence interval (95% CI) 1.02-178.05, p = 0.048] and length of aPL exposure (OR 1.41, 95% CI 1.04-1.92, p = 0.026) in model 2, while lupus anticoagulant showed a tendency to increase the risk (OR 7.10, 95% CI 0.86-58.78, p = 0.069) in model 1. Unlike age, lack of thromboprophylaxis, prolonged aPL exposure and lupus anticoagulant may increase the risk of thrombosis in aPL carriers.
Objectives: Health-related quality of life (HRQL) is a key factor in making anticoagulant treatment decisions. The objective of this study was to assess the HRQL of patients with nonvalvular atrial fibrillation by treatment type: direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Methods: We carried out a cross-sectional observational study with clinical practice data, gathering demographic and clinical variables. HRQL was measured using the 5-level 5dimension EuroQol questionnaire (EQ-5D-5L). Differences between the study groups in HRQL as measured by the EQ-5D-5L were analyzed using two-part multivariate regression models. First, using logistic regression, the adjusted probability, p(x), of having perfect health was estimated in each subgroup. Secondly, generalized linear models were used to estimate mean disutility values, w(x), in a population that does not have perfect health, i.e. utility less than 1 or 1-w(x). Results: We recruited 333 patients, of whom 126 were on DOACs and 207 on VKAs. A significant difference was observed in the EQ-5D-5L anxiety/depression dimension, with a higher percentage of patients classified in the 'no problems' category in the DOAC group. The same type of analysis did not identify significant differences in any of the other dimensions (mobility, self-care, usual activities or pain/discomfort). Discussion: In the multivariate model, utility was significantly higher in the DOAC group than in the VKA group, although the difference was small (0.0121). This difference is attributable to patients on DOACs having less anxiety/depression. Conclusion: Patients treated with DOACs report a slightly better quality of life than those treated with VKAs.
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