抗凝药物在房颤患者中的应用禁忌：英国初级保健数据的横断面分析。
The role of contraindications in prescribing anticoagulants to patients with atrial fibrillation: a cross-sectional analysis of primary care data in the UK.
机构信息
Institute of Applied Health Research, University of Birmingham, Birmingham.
出版信息
Br J Gen Pract. 2017 Sep;67(662):e588-e597. doi: 10.3399/bjgp17X691685. Epub 2017 Jun 19.
BACKGROUND
Underuse of anticoagulants in atrial fibrillation (AF) is an international problem, which has often been attributed to the presence of contraindications to treatment. No studies have assessed the influence of contraindications on anticoagulant prescribing in the UK.
AIM
To determine the influence of contraindications on anticoagulant prescribing in patients with AF in the UK.
DESIGN AND SETTING
Cross-sectional analysis of primary care data from 645 general practices contributing to The Health Improvement Network, a large UK database of electronic primary care records.
METHOD
Twelve sequential cross-sectional analyses were carried out from 2004 to 2015. Patients with a diagnosis of AF aged ≥35 years and registered for at least 1 year were included. Outcome measure was prescription of anticoagulant medication.
RESULTS
Over the 12 study years, the proportion of eligible patients with AF with contraindications who were prescribed anticoagulants increased from 40.1% (95% confidence interval [CI] = 38.3 to 41.9) to 67.2% (95% CI = 65.6 to 68.8), and the proportion of those without contraindications prescribed anticoagulants increased from 42.1% (95% CI = 41.6 to 42.6) to 67.7% (95% CI = 67.2 to 68.1). In patients with a recent history of major bleeding or aneurysm, prescribing rates increased from 44.3% (95% CI = 42.2 to 46.5) and 34.8% (95% CI = 29.4 to 40.6) in 2004 to 71.7% (95% CI = 69.9 to 73.5) and 63.2% (95% CI = 58.3 to 67.8) in 2015, respectively, comparable with rates in patients without contraindications.
CONCLUSION
The presence or absence of recorded contraindications has little influence on the decision to prescribe anticoagulants for the prevention of stroke in patients with AF. The study analysis suggests that, nationally, 38 000 patients with AF with contraindications are treated with anticoagulants. This has implications for patient safety.
背景
在心房颤动（AF）中抗凝剂的使用不足是一个国际性问题，这通常归因于存在治疗禁忌。尚无研究评估在英国，禁忌对抗凝剂处方的影响。
目的
确定在英国，AF 患者中禁忌对抗凝剂处方的影响。
设计和设置
从参与大型英国电子初级保健记录网络健康改善网络（The Health Improvement Network）的 645 家普通实践中进行的初级保健数据的横断面分析。
方法
2004 年至 2015 年期间进行了 12 项连续的横断面分析。纳入年龄≥35 岁并注册至少 1 年的 AF 诊断患者。结果指标是抗凝药物的处方。
结果
在 12 年的研究期间，有禁忌的合格 AF 患者中接受抗凝剂治疗的比例从 40.1%（95%置信区间[CI] = 38.3 至 41.9）增加到 67.2%（95% CI = 65.6 至 68.8），无禁忌的患者中接受抗凝剂治疗的比例从 42.1%（95% CI = 41.6 至 42.6）增加到 67.7%（95% CI = 67.2 至 68.1）。在近期有大出血或动脉瘤病史的患者中，处方率从 2004 年的 44.3%（95% CI = 42.2 至 46.5）和 34.8%（95% CI = 29.4 至 40.6）增加到 2015 年的 71.7%（95% CI = 69.9 至 73.5）和 63.2%（95% CI = 58.3 至 67.8），与无禁忌的患者相似。
结论
记录的禁忌的存在与否对预防 AF 患者中风使用抗凝剂的决定影响不大。该研究分析表明，在全国范围内，有 38000 名有禁忌的 AF 患者接受了抗凝剂治疗。这对患者安全有影响。
Zotero 插件