Lu Ting, Yang Zhe, Zhang Peipei, Zhu Haiyan, Chu Qiao, Jing Limei, Sun Wanju, Shi Jianwei
Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Shanghai YangZhi Rehabilitation Hospital, School of Medicine, Tongji University, Shanghai, 201619, China.
BMC Cardiovasc Disord. 2025 Aug 14;25(1):604. doi: 10.1186/s12872-025-05046-3.
To identify the characteristics of antiplatelet drug (APD) prescriptions based on a regional large-scale outpatient database in Shanghai, China, and to compare the practical usage of APDs with the respective clinical guidelines for patients with coronary artery disease (CAD) in China.
Outpatient electronic healthcare records were extracted from 20 medical institutions in Shanghai from January 2020 to October 2021. Outpatient APD prescriptions among CAD patients and their comorbidity status were analyzed with the χ test. The guideline adherence of specific APD regimens was also evaluated.
Of 1,532,972 outpatient visits, only 284,400 (18.55%) involved APDs. APD were more likely to be utilized in patients with recent ACS (27.60%) (χ = 888.475, P < 0.001), CCS (n = 280025, 18.46%, χ = 881.045, P < 0.001) and coexisting hyperlipidemia (n = 22,387, 29.07%, χ = 5938.871, P < 0.001), diabetes (n = 14,087, 22.92%, χ = 808.226, P < 0.001), hypertension (n = 40,193, 22.11%, χ = 1724.758, P < 0.001) and atherosclerosis (n = 439, 21.24%, χ = 9.885, P = 0.002). Recent ACS patient and CCS patients with all comorbidities were more prone to being treated with dual aspirin-clopidogrel therapy (P < 0.001). Dual aspirin-ticagrelor therapy was the second common choice for CCS patients (n = 210,230, 13.86%, χ = 9.274, P = 0.002), followed by aspirin (n = 203,551, 13.42%; χ = 59.267, P < 0.001), clopidogrel (n = 75,702, 4.99%; χ = 4276.533, P < 0.001), and ticagrelor monotherapy (n = 7,94, 0.52%; χ = 4276.533, P < 0.001). Among recent ACS patients, clopidogrel monotherapy was the second most frequently used (n = 2624, 16.50%; χ = 4304.044, P < 0.001), followed by dual aspirin-ticagrelor therapy (n = 2071, 13.03%; χ = 9.101, P = 0.003), aspirin monotherapy (n = 1082, 11.33%; χ = 58.818, P < 0.001), and ticagrelor monotherapy (n = 354, 2.23%; χ = 847.68, P < 0.001). The rationality analysis showed that for CCS, the rating was 3 (representing the average). For recent ACS and CAD with reflux esophagitis, APD prescription was not very consistent with the guidelines (rating = 2).
The proportion of APD prescriptions for CAD outpatients was lower than expected. The rationality analysis revealed that both CCS and recent ACS patients showed suboptimal guideline adherence in real-world APD prescriptions, especially for patients with comorbid reflux esophagitis. The gap indicated that real-world prescription activity for these diseases should receive more attention.
基于中国上海地区的一个区域性大型门诊数据库，确定抗血小板药物（APD）处方的特征，并将APD的实际使用情况与中国冠状动脉疾病（CAD）患者的相应临床指南进行比较。
提取2020年1月至2021年10月期间上海20家医疗机构的门诊电子医疗记录。采用χ检验分析CAD患者的门诊APD处方及其合并症状态。还评估了特定APD治疗方案的指南依从性。
在1532972次门诊就诊中，只有284400次（18.55%）涉及APD。近期急性冠状动脉综合征（ACS）患者（27.60%）更有可能使用APD（χ = 888.475，P < 0.001），慢性冠状动脉综合征（CCS）患者（n = 280025，18.46%，χ = 881.045，P < 0.001）以及合并高脂血症（n = 22387，29.07%，χ = 5938.871，P < 0.001）、糖尿病（n = 14087，22.92%，χ = 808.226，P < 0.001）、高血压（n = 40193，22.11%，χ = 1724.758，P < 0.001）和动脉粥样硬化（n = 439，21.24%，χ = 9.885，P = 0.002）的患者。近期ACS患者和所有合并症的CCS患者更倾向于接受阿司匹林 - 氯吡格雷双联治疗（P < 0.001）。阿司匹林 - 替格瑞洛双联治疗是CCS患者的第二常见选择（n = 210230，13.86%，χ = 9.274，P = 0.002），其次是阿司匹林（n = 203551，13.42%；χ = 59.267，P < 0.001）、氯吡格雷（n = 75702，4.99%；χ = 4276.533，P < 0.001）和替格瑞洛单药治疗（n = 794，0.52%；χ = 4276.533，P < 0.001）。在近期ACS患者中，氯吡格雷单药治疗是第二常用的（n = 2624，16.50%；χ = 4304.044，P < 0.001），其次是阿司匹林 - 替格瑞洛双联治疗（n = 2071，13.03%；χ = 9.101，P = 0.003）、阿司匹林单药治疗（n = 1082，11.33%；χ = 58.818，P < 0.001）和替格瑞洛单药治疗（n = 354，2.23%；χ = 847.68，P < 0.001）。合理性分析表明，对于CCS，评分为3（代表平均水平）。对于近期ACS和患有反流性食管炎的CAD患者，APD处方与指南不太一致（评分为2）。
CAD门诊患者的APD处方比例低于预期。合理性分析显示，CCS和近期ACS患者在实际APD处方中的指南依从性均不理想，尤其是对于合并反流性食管炎的患者。这一差距表明，这些疾病的实际处方情况应受到更多关注。
