Averlant Lorette, Ficheur Grégoire, Ferret Laurie, Boulé Stéphane, Puisieux François, Luyckx Michel, Soula Julien, Georges Alexandre, Beuscart Régis, Chazard Emmanuel, Beuscart Jean-Baptiste
Geriatrics Department, CHRU Lille, 2 Avenue Oscar Lambret, 59000, Lille, France.
EA 2694, Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lille, France.
Drugs Aging. 2017 Sep;34(9):701-710. doi: 10.1007/s40266-017-0477-3.
Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease.
We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease.
The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.
多项研究表明，在75岁及以上的房颤（AF）患者中，抗血小板治疗（APT）的处方与口服抗凝药（OAC）使用不足的风险增加有关。相关的动脉粥样硬化疾病可能是APT处方的潜在原因。本研究的目的是确定OAC使用不足与APT处方之间的关联是否可由动脉粥样硬化疾病的存在来解释。
我们基于管理数据在2009年至2013年间进行了一项回顾性、观察性、单中心研究。在一个包含72090次住院记录的数据库中识别出75岁及以上的非瓣膜性房颤患者。通过逻辑回归评估抗血栓药物的处方及其与动脉粥样硬化疾病存在的关联。共纳入2034次住院记录（平均年龄84.3±5.2岁）。已知动脉粥样硬化疾病的总体患病率为25.9%。在58.5%的住院记录中观察到OAC使用不足。在多变量分析中，APT的处方与OAC使用不足的风险增加相关[比值比（OR）6.85；95%置信区间（CI）5.50 - 8.58]，与是否存在已知的动脉粥样硬化疾病无关（OR 0.78；95% CI 0.60 - 1.01）。在692次APT单药治疗的住院记录中（34.0%），232次（33.5%）显示存在动脉粥样硬化疾病。
在老年房颤患者中，OAC使用不足与APT的处方有关，无论是否存在已知的动脉粥样硬化疾病。我们的结果表明，APT的处方往往不恰当，本应使用OAC。
