Department of Pharmacy, Toulouse University Hospital, Toulouse, France.
UMR 1027, Inserm, UPS Toulouse III University, Toulouse, France.
J Cardiovasc Pharmacol Ther. 2020 Jul;25(4):332-337. doi: 10.1177/1074248420917811. Epub 2020 Apr 8.
Oral anticoagulants are the first-line drugs for treating thrombotic disorders related to nonvalvular atrial fibrillation and for treating deep vein thrombosis, diseases that increase in prevalence with age. Older patients have a greater risk of thrombotic and hemorrhagic events and are more prone to drug interactions. Given this backdrop, we wanted to determine the factors associated with the prescription of direct oral anticoagulants and vitamin K antagonists in older patients.
We performed a cross-sectional observational study using a hospital prescription database. The study population consists of 405 older patients who were given oral anticoagulants. The 2 variables of interest were the prescription of 1 of the 2 classes of oral anticoagulants (direct oral anticoagulants vs vitamin K antagonists) and appropriateness of oral anticoagulant prescribing according to Summary of Product Characteristics (potentially inappropriate vs appropriate).
The factors associated with direct oral anticoagulant prescribing were the female gender (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.88) and initiation during hospital stay (OR: 2.56, 95% CI: [1.52-4.32]). Stage 4 and 5 chronic kidney diseases (OR: 0.39, 95% CI: [0.19-0.79] and OR: 0.07, 95% CI: [0.01-0.53]) were factors favoring vitamin K antagonist prescription. Being 90 years of age or more (OR: 2.05, 95% CI: [1.06-3.98]) was a factor for potentially inappropriate anticoagulant prescribing. The gastroenterology department (OR: 2.91, 95% CI: [1.05-8.11]) was associated with potentially inappropriate anticoagulant prescribing.
Direct oral anticoagulants are the drugs of choice for anticoagulant treatment, including in older adults. The female gender and the initiation during hospital stay increased the chances of being prescribed a direct oral anticoagulant in older adults. Stage 4 and 5 chronic kidney disease increased the likelihood of having a vitamin K antagonist prescribed. Our study also revealed a persistence of potentially inappropriate oral anticoagulant prescriptions in older patients.
口服抗凝剂是治疗与非瓣膜性心房颤动和深静脉血栓形成相关的血栓性疾病的一线药物，这些疾病随着年龄的增长而患病率增加。老年患者发生血栓形成和出血事件的风险更高，更容易发生药物相互作用。鉴于这种背景，我们希望确定与老年患者口服抗凝剂处方相关的因素。
我们使用医院处方数据库进行了一项横断面观察性研究。研究人群由 405 名接受口服抗凝剂治疗的老年患者组成。两个感兴趣的变量是 2 类口服抗凝剂之一的处方（直接口服抗凝剂与维生素 K 拮抗剂）和根据产品特性摘要（潜在不适当与适当）判断的口服抗凝剂处方的适当性。
与直接口服抗凝剂处方相关的因素是女性性别（优势比 [OR]：1.87，95%置信区间 [CI]：1.22-2.88）和住院期间开始治疗（OR：2.56，95% CI：[1.52-4.32]）。慢性肾脏病 4 期和 5 期（OR：0.39，95% CI：[0.19-0.79]和 OR：0.07，95% CI：[0.01-0.53]）是维生素 K 拮抗剂处方的有利因素。90 岁或以上（OR：2.05，95% CI：[1.06-3.98]）是潜在不适当抗凝剂处方的因素。胃肠病学系（OR：2.91，95% CI：[1.05-8.11]）与潜在不适当抗凝剂处方有关。
直接口服抗凝剂是抗凝治疗的首选药物，包括在老年患者中。女性性别和住院期间开始治疗增加了老年患者使用直接口服抗凝剂的可能性。慢性肾脏病 4 期和 5 期增加了开维生素 K 拮抗剂的可能性。我们的研究还表明，老年患者中仍然存在潜在不适当的口服抗凝剂处方。
