Trends in the prescription of novel oral anticoagulants in UK primary care
Trends in the prescription of novel oral anticoagulants in UK primary care
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DOI：
10.1111/bcp.13299
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发表时间：
2017-09-01
影响因子：
3.4
通讯作者：
Renoux, Christel
中科院分区：
文献类型：
--
作者：
Loo, Simone Y.;Dell'Aniello, Sophie;Renoux, Christel
目的：新型口服抗凝剂（NOACs）是维生素k拮抗剂（vka）的替代品，可用于预防血栓栓塞。目前尚不清楚自2008年首次引入noac以来，英国是如何采用noac的。本研究旨在描述英国noac处方的趋势，包括达比加群、利伐沙班和阿哌沙班。方法利用英国临床实践研究数据链（Clinical Practice Research Datalink），利用泊松回归计算2009 - 2015年noac和vka的新使用率。使用多变量逻辑回归确定与NOAC起始相关的患者特征。结果在研究期间，口服抗凝剂启动的总比率增加了58%[比率比（RR） 1.58；95%可信区间（CI） 1.23, 2.03]，即使新的VKA使用率下降了31% （RR 0.69; 95% CI 0.52, 0.93）。相比之下，NOAC的起始率增加，特别是从2012年开始，从2012年到2015年增加了17倍（RR 17.68; 95% CI 12.16, 25.71）。2015年口服抗凝药处方中，noac占56.5%，处方最多的是利伐沙班，其次是阿哌沙班，然后是达比加群。与vka相比，新的NOAC使用者患充血性心力衰竭、冠状动脉疾病和周围血管疾病的可能性更小，有缺血性中风史的可能性更大。结论在英国，自2009年以来，NOACs的起始率大幅上升，这些药物现已超过vka成为首选的抗凝剂。此外，开始使用noac的患者的特征随着时间的推移而改变，这应该在未来比较noac和vka的研究中得到考虑。
AIMSNovel oral anticoagulants (NOACs) are alternatives to vitamin-K antagonists (VKAs) for the prevention of thromboembolism. It is unclear how NOACs have been adopted in the UK since first introduced in 2008. The present study was conducted to describe the trends in the prescription of NOACs in the UK, including dabigatran, rivaroxaban and apixaban.METHODSUsing the UK's Clinical Practice Research Datalink, the rates of new use of NOACs and VKAs from 2009 to 2015 were calculated using Poisson regression. Patient characteristics associated with NOAC initiation were identified using multivariate logistic regression.RESULTSThe overall rate of oral anticoagulant initiation increased by 58% over the study period [rate ratio (RR) 1.58; 95% confidence interval (CI) 1.23, 2.03], even as the rate of new VKA use decreased by 31% (RR 0.69; 95% CI 0.52, 0.93). By contrast, the rate of initiation of NOAC increased, particularly from 2012 onwards, with a 17-fold increase from 2012 to 2015 (RR 17.68; 95% CI 12.16, 25.71). In 2015, NOACs accounted for 56.5% of oral anticoagulant prescriptions, with rivaroxaban prescribed most frequently, followed by apixaban and then dabigatran. Compared to VKAs, new NOAC users were less likely to have congestive heart failure, coronary artery disease and peripheral vascular disease, and more likely to have a history of ischaemic stroke.CONCLUSIONSIn the UK, the rate of initiation of NOACs has increased substantially since 2009, and these agents have now surpassed VKAs as the anticoagulant of choice. Moreover, the characteristics of patients initiated on NOACs have changed over time, and this should be accounted for in future studies comparing NOACs and VKAs.