急性住院老年人一级和二级心脑血管预防中抗血小板治疗的适宜性。
Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people.
机构信息
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
出版信息
Br J Clin Pharmacol. 2017 Nov;83(11):2528-2540. doi: 10.1111/bcp.13355. Epub 2017 Aug 1.
AIMS
Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile.
METHODS
Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles.
RESULTS
Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5-45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3-34.0%).
CONCLUSIONS
This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention.
目的
抗血小板治疗推荐用于二级预防心脑血管疾病，但一级预防仅建议极高危患者使用。基于此背景，本研究旨在评估根据患者风险概况，评估急性住院老年人抗血小板治疗的适宜性。
方法
数据来自 2012 年和 2014 年意大利和西班牙内科和老年病房的 REPOSI 登记处。选择可在出院时评估的≥65 岁住院患者。根据其一级或二级心血管预防情况评估抗血小板治疗的适宜性。
结果
共纳入 2535 例患者，2199 例可在出院时评估。总体上，959 例（43.6%，95%CI 41.5-45.7）患者处方了抗血小板药物，阿司匹林是最常选用的药物。在接受一级预防治疗的患者中，超过一半的患者处方不当（52.1%），主要是过度处方（155/209 例，74.2%）。另一方面，在二级预防中也存在高度不适当的处方不足（222/726 例，30.6%，95%CI 27.3-34.0%）。
结论
本研究在急性住院老年人中进行，结果显示接受抗血小板药物一级预防治疗的患者中，处方不当的程度较高，主要是过度处方。此外，尽管抗血小板药物在二级预防中有明确的获益，但仍有很大一部分有明确心脑血管疾病的患者处方不足。
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