Xie Charis Xuan, Robson John, Williams Crystal, Carvalho Chris, Rison Stuart, Raisi-Estabragh Zahra
Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
North East London Integrated Care System, Unex Tower, London, UK.
BJGP Open. 2022 Dec 20;6(4). doi: 10.3399/BJGPO.2022.0048. Print 2022 Dec.
Patients with both atrial fibrillation (AF) and cardiovascular disease (CVD) may receive dual antithrombotic therapy (DAT) with both an anticoagulant and ≥1 antiplatelet agents. Avoiding prolonged duration of DAT and use of gastroprotective therapies reduces bleeding risk.
To describe the extent and duration of DAT and use of gastroprotection in a primary care cohort of patients with AF.
DESIGN & SETTING: Observational study in 1.2 million people registered with GPs across four east London clinical commissioning groups (CCGs), covering prescribing from January 2020-June 2021.
In patients with AF, factors associated with DAT prescription, prolonged DAT prescription (>12 months), and gastroprotective prescription were characterised using logistic regression.
There were 8881 patients with AF, of whom 4.7% ( = 416) were on DAT. Of these, 65.9% ( = 274) were prescribed DAT for >12 months and 84.4% ( = 351) were prescribed concomitant gastroprotection. Independent of all other factors, females with AF were less likely to receive DAT than males (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.49 to 0.77). Similarly, older (aged ≥75 years) individuals (OR 0.79, 95% CI = 0.63 to 0.98) were less likely to receive DAT than younger patients. Among those with AF on DAT, pre-existing CVD (OR 3.33, 95% CI = 1.71 to 6.47) and South Asian ethnicity (OR 2.70, 95% CI = 1.15 to 6.32) were associated with increased gastroprotection prescriptions. Gastroprotection prescription (OR 1.80, 95% CI = 1.01 to 3.22) was associated with prolonged DAT prescription.
Almost two-thirds of patients with AF on DAT were prescribed prolonged durations of therapy. Prescription of gastroprotection therapies was suboptimal in one in six patients. Treatment decisions varied by sex, age, ethnic group, and comorbidity. Duration of DAT and gastroprotection in patients with AF requires improvement.
患有心房颤动（AF）和心血管疾病（CVD）的患者可能会接受抗凝剂和≥1种抗血小板药物的双重抗栓治疗（DAT）。避免延长DAT疗程并使用胃保护疗法可降低出血风险。
描述AF患者初级保健队列中DAT的范围和持续时间以及胃保护措施的使用情况。
对伦敦东部四个临床委托小组（CCG）登记的120万人进行观察性研究，涵盖2020年1月至2021年6月的处方情况。
在AF患者中，使用逻辑回归分析与DAT处方、延长DAT处方（>12个月）和胃保护处方相关的因素。
有8881例AF患者，其中4.7%（n = 416）接受DAT治疗。其中，65.9%（n = 274）接受DAT治疗超过12个月，84.4%（n = 351）接受了联合胃保护治疗。与所有其他因素无关，AF女性患者接受DAT治疗的可能性低于男性（比值比[OR] 0.61，95%置信区间[CI] = 0.49至0.77）。同样，年龄较大（≥75岁）的个体（OR 0.79，95% CI = 0.63至0.98）接受DAT治疗的可能性低于年轻患者。在接受DAT治疗的AF患者中，既往有CVD（OR 3.33，95% CI = 1.71至6.47）和南亚族裔（OR 2.70，95% CI = 1.15至6.32）与胃保护处方增加相关。胃保护处方（OR 1.80，95% CI = 1.01至3.22）与延长DAT处方相关。
接受DAT治疗的AF患者中，近三分之二的患者接受了延长疗程的治疗。六分之一的患者胃保护疗法的处方并不理想。治疗决策因性别、年龄、种族和合并症而异。AF患者的DAT疗程和胃保护措施需要改进。
