School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, No. 91 Hsueh-Shih road, Taichung, Taiwan 40402, Republic of China.
Eur J Clin Pharmacol. 2013 Mar;69(3):629-39. doi: 10.1007/s00228-012-1359-6. Epub 2012 Aug 9.
We examined the extent of concurrent use of antiplatelets, anticoagulants, or digoxin with Chinese medications (CMs) and identified its associated factors.
A retrospective cohort study was conducted using one million random samples from the Longitudinal Health Insurance Database 2005 in Taiwan. High-risk Western medications (HRWMs) focused on in this study were antiplatelets (aspirin, clopidogrel, dipyridamole, ticlopidine), anticoagulants (heparin, warfarin), and digoxin. Concurrent use was described as having an overlapping use period of HRWM with CMs any time in 2005. Baseline demographics, comorbidities, and health service utilizations between patients with and without concurrent HRWM-CM use were compared. Logistic regression analyses were performed to identify factors associated with incident concurrent use.
Of the 70,698 eligible HRWM users, 13.2 % used CMs concurrently for an average duration of 26.7 ± 43 days. The incidence of concurrent HRWM-CM use, which excluded prior CM use within 6 months preceding the first CM use, was 6.3 %. Warfarin or ticlopidine users were more likely to be prescribed with CMs than were the other HRWM users. Factors associated with an increasing incidence of concurrent HRWM-CM use included female sex, age 45-54 years, middle monthly income, higher number of outpatient visits or distinct prescribed medications, and a previous diagnosis of heart diseases, stroke, or hypertension. In contrast, age ≥ 65 years and higher medical expenditure were associated with a lower incidence of concurrent use.
In the Taiwanese population, approximately one in eight HRWM users were concomitantly prescribed CMs. Whether such concurrent use is associated with adverse clinical outcomes warrants further investigations.
本研究旨在调查台湾地区民众同时使用抗血小板药物、抗凝药物或地高辛与中药（CM）的情况，并确定其相关影响因素。
本研究采用回顾性队列研究，数据来源于台湾地区 2005 年纵向健康保险数据库中的 100 万随机抽样。本研究重点关注的高危西药（HRWM）包括抗血小板药物（阿司匹林、氯吡格雷、双嘧达莫、噻氯匹定）、抗凝药物（肝素、华法林）和地高辛。2005 年期间，任何时间内同时使用 HRWM 和 CM 则被定义为同时使用。比较同时使用 HRWM 和 CM 的患者与未同时使用 HRWM 和 CM 的患者的基线人口统计学特征、合并症和卫生服务利用情况。采用 logistic 回归分析确定与同时使用 HRWM 和 CM 相关的因素。
在 70698 名符合条件的 HRWM 使用者中，有 13.2%的患者同时使用了 CM，平均使用时间为 26.7±43 天。排除在首次使用 CM 前 6 个月内有 CM 使用史的情况下，同时使用 HRWM 和 CM 的发生率为 6.3%。与其他 HRWM 使用者相比，华法林或噻氯匹定使用者更有可能同时开具 CM。与同时使用 HRWM 和 CM 的发生率增加相关的因素包括女性、45-54 岁、中等月收入、更多的门诊就诊次数或更多的特定处方药物、以及先前诊断的心脏病、中风或高血压。相反，年龄≥65 岁和更高的医疗支出与同时使用的发生率较低相关。
在台湾地区人群中，约有八分之一的 HRWM 使用者同时开具了 CM。同时使用 CM 是否与不良临床结局相关，还需要进一步的研究。
