NISTICò F, Troiano G, Nante N, Dei S, Piacentini P
Demographic and Epidemiological System, AUSL Toscana Sud Est, Arezzo, Italy.
Post Graduate School of Public Health, University of Siena, Italy.
J Prev Med Hyg. 2018 Mar 30;59(1):E88-E91. doi: 10.15167/2421-4248/jpmh2018.59.1.722. eCollection 2018 Mar.
A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated with bleeding. The aim of our study was to analyze how the anticoagulant therapy with VKAs could affects the hospitalizations and the visits to emergency room in the elderly population (> 65 years old).
In 2013 we conducted a cross sectional study analyzing the database of all pharmaceutical prescriptions, selecting patients living in Grosseto (Italy), which received at least two prescriptions of coumarin derivatives in 2012. We analyzed the admissions to hospital and the accesses to the emergency rooms (ERs) made by each patient, focusing especially on those related to bleeding. For each access to ER we recorded the date, time of stay, diagnosis and outcome. For each hospitalization the information we recorded were the date of admission and discharge diagnosis.
3684 patients were included in our study. 261 (7.1%) patients visited the emergency room for bleeding; 37 (1%) for intracranial bleeding. The accesses made by men were higher than those made by women. The average time of stay in ER was 349 minutes. The admissions to hospital were 96 (2.6%); 42 (1.1%) were admitted to hospital with a diagnosis of major vascular event. 53 patients (20.3%), accessed to the ER more than one time. The 11.5% was admitted to the hospital more than one time.
Our study showed that VKAs are responsible of an increase of the accesses to ER and of the admissions to hospital. However, it would be interesting to enlarge the sample size including patients living in other provinces or in other regions, with a lower age and treated also with TSOACs, in order to evaluate the real cost-effectiveness of anticoagulant therapy.
许多药物类别都与可预防的药物相关住院情况有关。香豆素衍生物用于治疗和预防深静脉血栓形成或肺栓塞，或预防人工心脏瓣膜或心房颤动患者的全身性栓塞或中风，常与出血相关。我们研究的目的是分析维生素K拮抗剂（VKA）抗凝治疗如何影响老年人群（>65岁）的住院情况和急诊就诊情况。
2013年，我们进行了一项横断面研究，分析了所有药品处方数据库，选择居住在意大利格罗塞托、在2012年至少接受过两张香豆素衍生物处方的患者。我们分析了每位患者的住院情况和急诊就诊情况，尤其关注与出血相关的情况。对于每次急诊就诊，我们记录了日期、停留时间、诊断和结果。对于每次住院，我们记录的信息包括入院日期和出院诊断。
我们的研究纳入了3684名患者。261名（7.1%）患者因出血到急诊就诊；37名（1%）因颅内出血就诊。男性的就诊次数高于女性。在急诊的平均停留时间为349分钟。住院患者有96名（2.6%）；42名（1.1%）因重大血管事件入院。53名患者（20.3%）多次到急诊就诊。11.5%的患者多次住院。
我们的研究表明，VKA会导致急诊就诊和住院次数增加。然而，扩大样本量，纳入居住在其他省份或其他地区、年龄更小且也接受新型口服抗凝药（TSOAC）治疗的患者，以评估抗凝治疗的实际成本效益，将是很有意思的。
