Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan
Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan
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DOI：
10.1248/bpb.b18-00576
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发表时间：
2019-03-01
影响因子：
2
通讯作者：
Kawakami, Koji
中科院分区：
文献类型：
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作者：
Takeuchi, Masato;Nakano, Sayuri;Kawakami, Koji
华法林是一种用于抗凝治疗的药物，治疗范围较窄，且存在多种药物相互作用。因此，依从性和正确使用伴随药物是华法林治疗的疗效和安全性的基础。2012年，我们回顾性分析了日本三家大型连锁药店的数据。我们纳入了至少有一次华法林分配记录的所有20岁以上的成年人。我们检查了患者的人口统计学数据，通过药物拥有率（MPR）测量的依从性，以及共同分配，重点关注合并分配的数量和同时使用增加出血风险的药物。考虑到治疗窗较窄，将依从性不足和依从性过度的比例设定为1.1。我们回顾了71340例患者（中位年龄73岁，62%为男性）的443007份华法林处方记录。MPR为1.0（四分位数范围：0.96-1.0），分别有16.3%和1.9%的个体存在粘附不足和粘附过度。在每次药房会面中，共同分发的药物的中位数为8，这在年龄组之间没有差异。与高出血风险相关的药物在40.0%的就诊中分发，占所有共同分发药物的16.4%。总之，我们在日本研究人群中发现了最佳的总体依从性（通过MPR评估），即使定义了严格的临界值。然而，多种药物在所有年龄组中都很常见，并且具有高出血风险特征的药物通常与华法林共同分发。未来的研究解决这些分配模式如何影响患者的结果是必要的。
Warfarin is a drug used for anticoagulation management, with a narrow therapeutic range and multiple drug drug interactions. Adherence and proper use of concomitant medication are thus fundamental to the efficacy and safety of warfarin therapy. In 2012, we retrospectively analyzed data from three large-scale pharmacy chains in Japan. We included all adults 20 years old) with at least one record of warfarin dispensation. We examined patient demographic data, adherence as measured by medication possession ratio (MPR), and co-dispensation focusing on the number of concomitant dispensations and concurrent use of medications that increase bleeding risk. Thresholds of underadherence and overadherence were set at 1.1, considering the narrow therapeutic window. We reviewed 443007 warfarin dispensation records of 71340 individuals (median age, 73 years; 62% male). The MPR was 1.0 (interquartile range: 0.96-1.0), and underadherence and overadherence was found in 16.3 and 1.9% of individuals, respectively. The median number of co-dispensed drugs was eight at each pharmacy encounter, which did not differ by age group. Drugs associated with a high bleeding risk were dispensed in 40.0% of encounters and accounted for 16.4% of all co-dispensed drugs. In summary, we found optimal overall adherence, as assessed by MPR, among our Japanese study population, even when defining a strict cut-off value. However, polypharmacy was common in all age groups and medications with a high bleeding risk profile were often co-dispensed with warfarin. Future research addressing how these dispensation patterns affect patient outcome is warranted.