Puchon Erik, Goboova Maria, Vano Ivan, Fazekas Tomas, Javorova-Rihova Zuzana, Kuzelova Magdalena
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Kalinciakova 8, 832 32, Bratislava, Slovak Republic.
Department of Internal Medicine, Teaching Hospital Nitra, Spitalska 6, 950 01, Nitra, Slovak Republic.
Eur Geriatr Med. 2020 Dec;11(6):1051-1061. doi: 10.1007/s41999-020-00380-5. Epub 2020 Aug 17.
To investigate the relationship between medications with a known risk of gastrointestinal bleeding and proton pump inhibitor (PPI) prescription not according to guidelines.
An analysis of the records of 592 hospitalised patients aged 65 years or older was undertaken. The number of all medicines, potentially inappropriate medicines according to the EU(7)-PIM list and the Beers Criteria 2019 and medicines with a known risk of gastrointestinal bleeding, was compared in patients with PPI prescription not given based on guidelines and in patients with no PPI prescription.
Patients prescribed PPI not based on guidelines used more medications on average (9.6 vs. 6.4, p < 0.001), more PIMs according to the EU(7)-PIM list (2.4 vs. 1.1, p < 0.001) and the Beers criteria (2.0 vs. 0.6, p < 0.001) at hospital admission and at discharge (8.9 vs. 7.5, p < 0.001, mean number of medications), (2.0 vs. 1.2, p < 0.001, EU(7)-PIM list), (1.9 vs. 0.8, p < 0.001, Beers criteria) than patients with no PPI prescription. Patients prescribed PPI not according to guidelines were more frequently using direct oral anticoagulants (28% vs. 12.8%, p < 0.001), corticosteroids (5.3% vs. 0.7%, p = 0.025) at hospital admission and at discharge (25.9% vs. 16.5%, p = 0.018, oral anticoagulants), (6.6% vs. 1%, p = 0.006, corticosteroids), (13.3% vs. 5.4%, p = 0.004, warfarin) than patients with no PPI prescription.
The number of medications, potentially inappropriate medications according to the EU(7)-PIM list and Beers criteria, and the use of direct oral anticoagulants, warfarin and corticosteroid prescriptions were the medication-related factors associated with PPI prescription not according to guidelines in elderly patients.
研究已知有胃肠道出血风险的药物与未按指南开具质子泵抑制剂（PPI）处方之间的关系。
对592名65岁及以上住院患者的记录进行分析。比较了未按指南开具PPI处方的患者和未开具PPI处方的患者中所有药物的数量、根据欧盟（7）-PIM清单和2019年Beers标准判定的潜在不适当药物的数量以及已知有胃肠道出血风险的药物的数量。
未按指南开具PPI处方的患者在入院时和出院时平均使用的药物更多（9.6种对6.4种，p<0.001），根据欧盟（7）-PIM清单判定的潜在不适当药物更多（2.4种对1.1种，p<0.001），根据Beers标准判定的潜在不适当药物也更多（2.0种对0.6种，p<0.001）（平均药物数量：8.9种对7.5种，p<0.001），（欧盟（7）-PIM清单：2.0种对1.2种，p<0.001），（Beers标准：1.9种对0.8种，p<0.001）。未按指南开具PPI处方的患者在入院时和出院时更频繁地使用直接口服抗凝剂（28%对12.8%，p<0.001）、皮质类固醇（5.3%对0.7%，p=0.025）（口服抗凝剂：25.9%对16.5%，p=0.018），（皮质类固醇：6.6%对1%，p=0.006），（华法林：13.3%对5.4%，p=0.004）。
药物数量、根据欧盟（7）-PIM清单和Beers标准判定的潜在不适当药物数量以及直接口服抗凝剂、华法林和皮质类固醇处方的使用是与老年患者未按指南开具PPI处方相关的药物相关因素。
