Wu Mingfen, Jiang Hailun, Yu Kefu, Zhao Zhigang, Zhu Bin
Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Pharmacol. 2024 Mar 12;15:1304139. doi: 10.3389/fphar.2024.1304139. eCollection 2024.
Novel oral anticoagulants (NOACs) have been recommended by guidelines as the first-line drugs for preventing cardiogenic stroke. We aimed to provide an overview of the prescription trends and dosing appropriateness of NOACs in China. We conducted a retrospective analysis of NOAC prescriptions using the Hospital Prescription Analysis Cooperation Project data from 2016 to 2022. Various patient features, such as gender, age, city, year, source, department visited, original diagnosis, dosing, cost, and insurance type, were collected and analyzed to examine the trends and dosing appropriateness of NOAC usage in ischemic stroke patients. 62,014 NOAC prescriptions were analyzed, including 16,602 for dabigatran, 45,253 for rivaroxaban, and 159 for apixaban. 85.14% of the patients were aged 65 or above, and tertiary hospitals accounted for 95.97% of NOAC prescriptions. NOAC prescriptions rose from 1828 in 2016 to 13,998 in 2021 but dropped to 13,166 in 2022. The percentage of annual prescriptions for NOACs among stroke patients has increased from 0.05% in 2016 to 0.37% in 2022. Total drug cost increased from ¥704541.18 in 2016 to ¥4128648.44 in 2021, then decreased to ¥1680109.14 in 2022. Prescriptions were divided into 48,321 appropriate and 11,262 inappropriate dosing groups, showing significant differences in medications, age, year, city type, hospital level, source, insurance type, and department visited (all < 0.001). The median drug cost for inappropriate dosing was higher than for appropriate dosing (¥55.20 VS ¥83.80). The top comorbidities in ischemic stroke patients were atrial fibrillation (35.30%), hypertension (32.75%), and coronary heart disease (16.48%). The application of NOACs in the Chinese population is increasing. Our findings highlight the frequent deviation from labeled dosing of NOACs in clinical practice. Continued efforts are necessary to promote the appropriate use of NOACs according to the standard dosage in the drug insert.
新型口服抗凝药（NOACs）已被指南推荐为预防心源性卒中的一线药物。我们旨在概述中国NOACs的处方趋势和给药合理性。我们利用2016年至2022年医院处方分析合作项目的数据对NOACs处方进行了回顾性分析。收集并分析了各种患者特征，如性别、年龄、城市、年份、来源、就诊科室、初始诊断、给药剂量、费用和保险类型，以研究缺血性卒中患者使用NOACs的趋势和给药合理性。共分析了62014份NOACs处方，其中达比加群16602份，利伐沙班45253份，阿哌沙班159份。85.14%的患者年龄在65岁及以上，三级医院的NOACs处方占95.97%。NOACs处方从2016年的1828份增至2021年的13998份，但在2022年降至13166份。卒中患者中NOACs的年度处方比例已从2016年的0.05%增至2022年的0.37%。药品总费用从2016年的704541.18元增至2021年的412864&44元，随后在2022年降至1680109.14元。处方分为48321份给药合理组和11262份给药不合理组，在用药、年龄、年份、城市类型、医院级别、来源、保险类型和就诊科室方面存在显著差异（均<0.001）。给药不合理的中位药品费用高于给药合理的费用（55.20元对83.80元）。缺血性卒中患者最常见的合并症是心房颤动（35.30%）、高血压（32.75%）和冠心病（16.48%）。NOACs在中国人群中的应用正在增加。我们的研究结果突出了临床实践中NOACs给药经常偏离标签剂量的情况。有必要继续努力促进按照药品说明书中的标准剂量合理使用NOACs。
