Sáez María E, González-Pérez Antonio, Johansson Saga, Nagy Péter, Rodríguez Luis A García
Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain.
AstraZeneca R&D, Mölndal, Sweden.
J Cardiovasc Pharmacol Ther. 2015 Jul;20(4):378-86. doi: 10.1177/1074248414562910. Epub 2014 Dec 11.
Antiplatelet (AP) therapy is well established for the secondary prevention of acute coronary events. However, patients may discontinue treatment, often owing to gastrointestinal (GI) complications, leaving them at elevated risk of recurrent cardiovascular events.
This descriptive retrospective study assessed trends in prescription of AP agents and coprescription of gastroprotective therapy, after an acute coronary event. Discontinuation of AP therapy within 2 years of an event and factors predicting discontinuation were investigated.
The study was conducted in a UK primary care setting from 2000 to 2008; a total of 27, 351 patients aged 50 to 84 years were included in the analysis. Main outcome measures were exposures to low-dose acetylsalicylic acid (ASA), clopidogrel, and proton pump inhibitors (PPIs).
At 90 days after an acute coronary event, 85.9% of patients had been prescribed some form of AP therapy and 33.6% of patients who were issued at least 1 ASA prescription in this period were also issued a PPI prescription. The use of dual antiplatelet therapy (DAT) 90 days after an event increased from 2% in 2000 to over 50% in 2008. An estimated 15.1% of patients on ASA monotherapy and 37.5% on DAT discontinued treatment within 1 year. A bleeding event during follow-up, including upper GI bleeding or hemorrhagic stroke, was the strongest predictor of discontinuation.
Although most patients were prescribed AP therapy in the 90 days following an acute coronary event, a substantial proportion discontinued DAT or ASA monotherapy within 1 year. It is essential that physicians consider strategies to reduce the risk of discontinuation of AP therapy.
抗血小板（AP）治疗在急性冠脉事件的二级预防中已得到广泛应用。然而，患者可能会中断治疗，这通常是由于胃肠道（GI）并发症，从而使他们面临心血管事件复发的风险升高。
这项描述性回顾性研究评估了急性冠脉事件后AP药物处方趋势以及胃保护治疗的联合处方情况。研究还调查了事件发生后2年内AP治疗的中断情况以及预测中断的因素。
该研究于2000年至2008年在英国初级医疗环境中进行；共有27351名年龄在50至84岁之间的患者纳入分析。主要观察指标为低剂量阿司匹林（ASA）、氯吡格雷和质子泵抑制剂（PPI）的使用情况。
急性冠脉事件发生后90天，85.9%的患者接受了某种形式的AP治疗，在此期间至少开具过1次ASA处方的患者中，33.6%同时也开具了PPI处方。事件发生后90天双联抗血小板治疗（DAT）的使用率从2000年的2%增加到2008年的超过50%。估计接受ASA单药治疗的患者中有15.1%以及接受DAT治疗的患者中有37.5%在1年内中断了治疗。随访期间发生的出血事件，包括上消化道出血或出血性卒中，是治疗中断的最强预测因素。
尽管大多数患者在急性冠脉事件后的90天内接受了AP治疗，但仍有相当一部分患者在1年内中断了DAT或ASA单药治疗。医生必须考虑采取策略来降低AP治疗中断的风险。
