"Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France.
"Mutualité Sociale Agricole" of Burgundy, Dijon, France.
Int J Clin Pract. 2020 Jan;74(1):e13420. doi: 10.1111/ijcp.13420. Epub 2019 Oct 24.
Direct oral anticoagulants (DOACs) are increasingly prescribed to elderly people, but the epidemiologic data for this population remains scarce. We compared the elderly population taking DOACs and those not taking DOACs (noDOAC).
We included individuals over 75 years old, affiliated to Mutualité Sociale Agricole of Burgundy (a French regional health insurance agency), who had been refunded for a prescribed DOAC between 1st and 30th September 2017. The DAOC group (DAOCG) and noDOAC group (noDOACG) were compared in terms of demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs. In the DOACG, we compared the type of prescribing physician and laboratory monitoring for novel prescriptions (initial) and prescription refills (≥ 3 months).
Of the 19 798 included patients, 1518 (7.7%) were prescribed DAOCs and 18 280 (92.3%) were not. Mean and median age was 85 years in the 2 groups (DOACG and noDOACG). In the DOACG, there were more men (50% vs 40.2%), more RCD (88.9% vs 68.7%) and more drugs per prescription (6 ± 2.8 vs 5 ± 2.9) (All P < .01). The DOACG also took more antihypertensive drugs. The most commonly prescribed DOACs were apixaban (42.9%) followed by rivaroxaban (38.4%) and dabigatran (18.6%). Complete blood count, serum creatinine and coagulation function tests were requested for 69.4%, 75% and 22.2%, respectively, of patients prescribed DAOCs.
The DOACG had more RCD and drugs per prescription than the noDOACG; routine laboratory monitoring was insufficient. What's known Platelet aggregation inhibitors (low-dose) are recommended for secondary prevention of cardiovascular events in patients suffering from symptomatic atherosclerosis. The main risk of this treatment is bleeding. What's new A prescription for platelet aggregation inhibitors was found in 34% of geriatric inpatients in this prospective study. Compliance to guidelines was better for symptomatic peripheral artery disease than for primary prevention in accordance with recent publications. Geriatric comorbidities had no impact on the prescription of platelet aggregation inhibitors. Underuse of platelet aggregation inhibitors was observed in 11.3% of cases and overuse in 13.7% of cases.
直接口服抗凝剂（DOACs）越来越多地用于老年人，但针对该人群的流行病学数据仍然很少。我们比较了服用 DOAC 和未服用 DOAC（非 DOAC）的老年人。
我们纳入了年龄在 75 岁以上、参加勃艮第 Mutualité Sociale Agricole（法国地区健康保险公司）的个体，他们在 2017 年 9 月 1 日至 30 日期间被开具 DOAC 处方。DOAC 组（DOACG）和非 DOAC 组（noDOACG）在人口统计学条件、登记的慢性疾病（RCD）以及开具的药物数量和类型方面进行了比较。在 DOACG 中，我们比较了新型处方（初始）和处方续开（≥3 个月）的开具医生类型和实验室监测情况。
在 19798 名纳入患者中，有 1518 名（7.7%）服用 DOAC，18280 名（92.3%）未服用 DOAC。两组（DOACG 和 noDOACG）的平均和中位数年龄均为 85 岁。在 DOACG 中，男性更多（50% vs 40.2%），RCD 更多（88.9% vs 68.7%），处方药物数量更多（6 ± 2.8 对 5 ± 2.9）（均 P<.01）。DOACG 还服用了更多的降压药物。最常开具的 DOAC 是阿哌沙班（42.9%），其次是利伐沙班（38.4%）和达比加群（18.6%）。开具 DOAC 的患者中，分别有 69.4%、75%和 22.2%的患者要求进行全血细胞计数、血清肌酐和凝血功能检查。
DOACG 比 noDOACG 有更多的 RCD 和处方药物；常规实验室监测不足。
血小板聚集抑制剂（低剂量）推荐用于有症状动脉粥样硬化患者的心血管事件二级预防。这种治疗的主要风险是出血。
在这项前瞻性研究中，34%的老年住院患者开具了血小板聚集抑制剂处方。根据最近的出版物，对于有症状的外周动脉疾病，遵循指南的依从性优于一级预防。老年合并症对血小板聚集抑制剂的开具没有影响。在 11.3%的病例中观察到血小板聚集抑制剂的使用不足，在 13.7%的病例中观察到过度使用。
