Simpson Bryan H, Reith David, Medlicott Natalie J, Smith Alesha
University of Otago, School of Pharmacy Dunedin, New Zealand.
University of Otago, School of Medicine, Department of Women's and Children's Health, Dunedin, New Zealand.
J Prim Health Care. 2018 Dec;10(4):303-311. doi: 10.1071/HC17081.
INTRODUCTION Dabigatran etexilate is now prescribed for 51% of the patients receiving oral anticoagulation treatment in New Zealand. Its prescribing trends in relation to patient outcomes are, however, largely unknown for these patients. AIM To describe patient characteristics, effectiveness and safety of treatment with dabigatran etexilate in the New Zealand population. METHODS This retrospective cohort study used administrative health data for patients dispensed dabigatran etexilate between 1 July 2011 and 31 December 2015. Adverse events (haemorrhage) and treatment failure (thromboembolism or cerebrovascular accident) data were extracted and linked to patient-specific demographic data. Baseline patient characteristics were analysed with descriptive statistics to examine trends in dabigatran etexilate prescribing. Raw and adjusted hazard ratios (HRs), including covariates, were derived using Cox proportional hazard models. RESULTS In total, 52,413 patients were dispensed dabigatran etexilate. Multivariate analysis indicated the risk of haemorrhagic events were significantly increased for Māori (HR and 95% Confidence Interval (CI): 2.10 (1.54-2.86)) and Pacific Peoples (HR = 2.20 (1.49-3.24)); those aged >80 years (HR = 1.25 (1.08-1.43)); and more deprived populations in quintile 4 (HR = 1.24 (1.08-1.43)) and quintile 5 (HR = 1.30 (1.12-1.50)). There was an increased risk of thromboembolism and cerebrovascular accident among people aged >80 years (HR = 1.79 (1.49-2.15)). DISCUSSION Demographic factors are associated with adverse outcomes in patients treated with dabigatran etexilate. Targeted strategies are needed to prescribe dabigatran etexilate more appropriately in these populations.
引言 在新西兰，接受口服抗凝治疗的患者中有51%正在使用达比加群酯进行治疗。然而，对于这些患者，其用药趋势与患者预后之间的关系在很大程度上尚不清楚。目的 描述新西兰人群使用达比加群酯治疗的患者特征、有效性和安全性。方法 这项回顾性队列研究使用了2011年7月1日至2015年12月31日期间配发达比加群酯的患者的行政健康数据。提取不良事件（出血）和治疗失败（血栓栓塞或脑血管意外）数据，并将其与患者特定的人口统计学数据相关联。使用描述性统计分析基线患者特征，以研究达比加群酯的用药趋势。使用Cox比例风险模型得出包括协变量在内的原始和调整后的风险比（HR）。结果 共有52413名患者配发了达比加群酯。多变量分析表明，毛利人（HR及95%置信区间（CI）：2.10（1.54 - 2.86））、太平洋岛民（HR = 2.20（1.49 - 3.24））、年龄大于80岁的人群（HR = 1.25（1.08 - 1.
