Department of Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Comprehensive Unit for Health Economic Evidence Review and Decision Support, Ritsumeikan University, Kyoto, Japan.
Sci Rep. 2023 Jan 5;13(1):192. doi: 10.1038/s41598-022-26741-7.
The introduction of direct oral anticoagulants (DOACs) has greatly changed the use of anticoagulant therapy in patients with non-valvular atrial fibrillation (Af). Therefore, this study aimed to examine changes in the proportions of oral anticoagulant prescriptions in patients with non-valvular Af aged ≥ 65 years, taking into consideration the risk of cerebral infarction and bleeding. Anticoagulant prescriptions in outpatients aged ≥ 65 years with Af were temporally analyzed using the nationwide claims database in Japan. Trends in anticoagulant prescriptions were examined according to cerebral infarction and bleeding risk. The proportion of anticoagulant prescriptions for 12,076 Af patients increased from 41% in 2011 to 56% in 2015. An increase in DOAC prescriptions was accompanied by an increase in the proportion of anticoagulant prescriptions in each group according to the CHA2DS2-VASc and HAS-BLED scores. The proportion of anticoagulant prescriptions for patients with a high risk of developing cerebral infarction and bleeding showed a marked increase. Trends in anticoagulant prescriptions in Af patient with a CHADS-VASc score ≥ 2 and HAS-BLED scores ≥ 3 showed a marked increase in DOAC prescriptions. The widespread use of DOACs greatly changes the profile the prescription of anticoagulant therapy in patients with Af.
直接口服抗凝剂（DOACs）的引入极大地改变了非瓣膜性心房颤动（Af）患者抗凝治疗的应用。因此，本研究旨在考察考虑到脑梗死和出血风险后，≥65 岁非瓣膜性 Af 患者口服抗凝药物处方的比例变化。本研究使用日本全国范围内的索赔数据库对≥65 岁 Af 门诊患者的抗凝药物处方进行了时间性分析。根据脑梗死和出血风险，考察了抗凝药物处方的趋势。12076 例 Af 患者的抗凝药物处方比例从 2011 年的 41%增加到 2015 年的 56%。随着 DOAC 处方的增加，根据 CHA2DS2-VASc 和 HAS-BLED 评分，每个组中的抗凝药物处方比例也有所增加。发生脑梗死和出血风险高的患者的抗凝药物处方比例显著增加。CHADS-VASc 评分≥2 和 HAS-BLED 评分≥3 的 Af 患者的抗凝药物处方趋势显示，DOAC 处方明显增加。DOAC 的广泛使用极大地改变了 Af 患者抗凝治疗处方的模式。
