PRescriptiOn PattERns of Oral Anticoagulants in Nonvalvular Atrial Fibrillation (PROPER study)
PRescriptiOn PattERns of Oral Anticoagulants in Nonvalvular Atrial Fibrillation (PROPER study)
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DOI：
10.1177/1076029615614395
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发表时间：
2017-05-01
影响因子：
2.9
通讯作者：
Biteker, Murat
中科院分区：
文献类型：
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作者：
Basaran, Ozcan;Basaran, Nesrin Filiz;Biteker, Murat
简介：口服抗凝剂（OAC）的不当使用尚未得到充分研究，但在非瓣膜性房颤（NVAF）患者的实际实践中可能很常见。本研究旨在评价真实临床环境中NVAF患者的处方模式和OAC的适当性。方法：我们进行了一项前瞻性、观察性研究（NCT 02366338）。共筛选了148例NVAF患者的OAC处方。使用药物适当性指数（MAI）的9个标准评估处方的适当性：适应症，选择，剂量，给药方式和实用性，药物-药物相互作用，药物-疾病相互作用，重复和持续时间。对于每个标准，评价者必须评定药物是否（A）适当，（B）不适当但临床重要性有限，以及（C）不适当。结果如下：在148例患者中，73例（50%）接受华法林治疗（第1组），39例（26%）接受利伐沙班治疗（第2组），36例（24%）接受达比加群治疗（第3组）。MAI显示，83%的第1组患者、28%的第2组患者和47%的第3组患者至少有1个不适当的标准。此外，根据选择标准，37%的第1组、8%的第2组和5%的第3组被评为不适当，77%的第1组、23%的第2组和42%的第3组被评为剂量不适当。结论：NVAF患者中不适当的药物使用频繁，不仅是华法林，而且是NOAC。尽管NVAF的血栓预防有明显改善，但仍需要更多的努力来适当使用OAC。
Introduction: Inappropriate use of oral anticoagulants (OACs) have not been well investigatedand, however, may be frequent in real-world practice in patients with nonvalvular atrial fibrillation (NVAF). This study was designed to evaluate the prescription patterns and appropriateness of OACs in patients with NVAF in real-world clinical settings. Methods: We performed a prospective, observational study (NCT02366338). A total of 148 patients with NVAF were screened for OAC prescription. Appropriateness of prescribing was evaluated using 9 criteria of the Medication Appropriateness Index (MAI): indication, choice, dosage, modalities and practicability of administration, drug-drug interactions, drug-disease interactions, duplication, and duration. For each criterion, the evaluator has to rate whether the medication is (A) appropriate, (B) inappropriate but with limited clinical importance, and (C) inappropriate. Results: Of 148 patients, 73 (50%) were on warfarin (group 1), 39 (26%) were on rivaroxaban (group 2), and 36 (24%) were on dabigatran therapy (group 3). The MAI showed that 83% of group 1, 28% of group 2, and 47% of group 3 patients had at least 1 inappropriate criterion. Moreover, according to the choice criterion, 37% of group 1, 8% of group 2 and 5% of group 3 were rated as inappropriate, and dosage was not appropriate in 77% of group 1, 23% of group 2, and 42% of group 3. Conclusion: Inappropriate drug use is frequent among patients with NVAF not only for warfarin but also for NOACs. Although there is an apparent improvement in thromboprophylaxis of NVAF, much more effort is needed for appropriate use of OACs.