King's College London, Population Health and Environmental Sciences, London, UK; NIHR, Biomedical Research Centre at Guy's and St Thomas NHS Foundation Trust, London, UK.
King's College London, Population Health and Environmental Sciences, London, UK.
Ann Epidemiol. 2018 Jul;28(7):440-446. doi: 10.1016/j.annepidem.2018.03.006. Epub 2018 Mar 19.
This study aimed to estimate trends in antithrombotic prescriptions from 2001 to 2015 among people aged 80 years and over within clinical indications.
A prospective cohort study with 215,559 participants registered with the UK Clinical Practice Research Datalink from 2001 to 2015 was included in the analyses. The prevalence and incidence of antiplatelet and anticoagulant drugs were estimated for each year and by five clinical indications.
The prevalence rate of antithrombotic prescriptions among patients aged over 80 years and diagnosed with atrial fibrillation increased from 53% in 2001 to 77% in 2015 (P <.001). Anticoagulant prescriptions rates also increased five-fold in older adults with atrial fibrillation from around 10% in 2001 to 46% in 2015 (P <.001). Clopidogrel-prescribing rates in patients aged over 80 years and with venous thrombosis increased from 0.4% in 2001 to 10% in 2015 (P <.001). Warfarin-prescribing rates in older patients with venous thrombosis increased from 13% in 2001 to 21% in 2015 (P <.001).
The use of antithrombotic drugs increased from 2001 to 2015 in people aged 80 years and over across multiple clinical indications. Assessing the benefits and harms of antithrombotic drugs across different clinical indications in older people is a priority.
本研究旨在评估 2001 年至 2015 年间 80 岁及以上人群在临床指征下抗血栓药物处方的趋势。
本研究为前瞻性队列研究，纳入 2001 年至 2015 年间在英国临床实践研究数据链中注册的 215559 名参与者。每年及五种临床指征下估计抗血小板和抗凝药物的患病率和发病率。
在诊断为房颤的 80 岁以上患者中，抗血栓药物处方的患病率从 2001 年的 53%增加到 2015 年的 77%（P<0.001）。在有房颤的老年患者中，抗凝药物处方率也增加了五倍，从 2001 年的 10%左右增加到 2015 年的 46%（P<0.001）。在 80 岁以上患有静脉血栓形成的患者中，氯吡格雷的处方率从 2001 年的 0.4%增加到 2015 年的 10%（P<0.001）。在患有静脉血栓形成的老年患者中，华法林的处方率从 2001 年的 13%增加到 2015 年的 21%（P<0.001）。
在多种临床指征下，80 岁及以上人群的抗血栓药物使用率从 2001 年增加到 2015 年。评估不同临床指征下抗血栓药物在老年人中的获益和危害是当务之急。
