Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Thailand.
Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
Br J Clin Pharmacol. 2021 Mar;87(3):1056-1068. doi: 10.1111/bcp.14464. Epub 2020 Jul 23.
Oral anticoagulant (OAC) is recommended for preventing stroke in atrial fibrillation (AF). However, the OAC utilisation in AF patients with dementia or cognitive impairment (CI) is limited. This study aimed to examine the prevalence of OAC prescriptions in AF patients with dementia/CI and to identify factors associated with OAC treatment within 180 days after dementia/CI diagnosis.
Using The Health Improvement Network database, the annual trends of OAC between 2000 and 2015 were calculated. Multivariable logistic regression was performed to identify factors associated with OAC treatment.
The prevalence rate of OAC prescriptions increased from 6.1% in 2000 to 45.9% in 2015. Among OAC users, the proportion of direct oral anticoagulants (DOACs) use increased significantly from 0.1% in 2011 to 33.8% in 2015 (P-trend < 0.001), while the proportion of vitamin K antagonist use decreased by 28.6% from 100% in 2000 to 71.4% in 2015 (P-trend < 0.001). In the multivariable analysis, younger age, very old age, female sex, higher Charlson Comorbidity Index, having a HAS-BLED score ≥3, a history of intracranial bleeding, falls and polypharmacy were significantly associated with lower odds of receiving OAC.
In UK primary care, OAC use increased from 2000 to 2015 in AF patients with dementia/CI, with a substantial increase in use of DOACs. Characteristics related to frailty are associated with lower odds of OAC prescription. Given the increasing use of DOACs in patients with dementia/CI, further studies are needed to investigate the safety and effectiveness of DOACs in this important patient group.
口服抗凝剂 (OAC) 被推荐用于预防房颤 (AF) 中的中风。然而，痴呆或认知障碍 (CI) 的 AF 患者的 OAC 使用受到限制。本研究旨在检查痴呆/CI 后 180 天内 OAC 处方在 AF 患者中的流行率，并确定与 OAC 治疗相关的因素。
使用健康改善网络数据库，计算了 2000 年至 2015 年 OAC 的年度趋势。采用多变量逻辑回归分析确定与 OAC 治疗相关的因素。
OAC 处方的患病率从 2000 年的 6.1%增加到 2015 年的 45.9%。在 OAC 使用者中，直接口服抗凝剂 (DOAC) 的使用比例从 2011 年的 0.1%显著增加到 2015 年的 33.8%（P 趋势<0.001），而维生素 K 拮抗剂的使用比例从 2000 年的 100%下降到 2015 年的 71.4%（P 趋势<0.001）。多变量分析显示，年龄较轻、年龄较大、女性、较高的 Charlson 合并症指数、HAS-BLED 评分≥3、颅内出血史、跌倒和多药治疗与接受 OAC 的可能性较低显著相关。
在英国初级保健中，痴呆/CI 的 AF 患者中 OAC 的使用从 2000 年到 2015 年有所增加，DOAC 的使用显著增加。与虚弱相关的特征与 OAC 处方的可能性较低相关。鉴于 DOAC 在痴呆/CI 患者中的使用增加，需要进一步研究以调查 DOAC 在这一重要患者群体中的安全性和有效性。
