Contemporary Trends in Oral Antiplatelet Agent Use in Patients Treated with Percutaneous Coronary Intervention for Acute Coronary Syndrome
Contemporary Trends in Oral Antiplatelet Agent Use in Patients Treated with Percutaneous Coronary Intervention for Acute Coronary Syndrome
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DOI：
10.18553/jmcp.2017.23.1.57
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发表时间：
2017-01-01
影响因子：
2.1
通讯作者：
Walton, Surrey M.
中科院分区：
文献类型：
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作者：
Kim, Kibum;Lee, Todd A.;Walton, Surrey M.
背景技术背景：最近的试验证明了普拉格雷和替格瑞洛与氯吡格雷相比在减少急性冠状动脉综合征（ACS）患者心血管并发症方面的疗效。然而，目前尚不清楚自新药问世以来，商业保险患者中3种抗血小板药物的使用情况发生了怎样的变化。（a）描述普拉格雷和替格瑞洛在接受经皮冠状动脉介入治疗（PCI）治疗ACS发作的患者中的应用，（B）探讨与药物选择相关的患者因素，以深入了解这些抗血小板药物的利用模式。从2009年至2013年期间的保险索赔中确定了因ACS接受PCI住院治疗后接受新的抗血小板药物分配的患者。根据ACS事件前6个月的时间确定人口统计学和共病状况。使用按月和季度划分的描述性统计量说明抗血小板药物选择的纵向趋势。使用逐步模型选择的逻辑回归，与使用新药物相关的因素，以及替格瑞洛和普拉格雷之间的选择，被identified.RESULTS：分析包括66，335名受试者。到2011年底，氯吡格雷的使用从抗血小板药物总使用量的100%降至约65%，此后趋于平稳。2011年替格瑞洛的引入恰逢普拉格雷的开始从2013年12月的35%下降到18%。与使用氯吡格雷相比，使用新药物与年轻相关（
BACKGROUND: Recent trials demonstrated the efficacy of prasugrel and ticagrelor compared with clopidogrel in the reduction of cardiovascular complications in patients with acute coronary syndrome (ACS). However, it is unclear how use of the 3 antiplatelet medications has changed in commercially insured patients since the advent of the new agents.OBJECTIVES: To (a) describe the adoption of prasugrel and ticagrelor in patients who received percutaneous coronary intervention (PCI) for the onset of ACS and (b) explore patient factors associated with the selection of the drug to provide insight into utilization patterns of these antiplatelet agents.METHODS: Patients who received a new dispensing of an antiplatelet agent following a hospitalization for a PCI administered for ACS were identified from insurance claims between 2009 and 2013. Demographics and comorbid conditions were determined based on a 6-month period before the ACS event. Longitudinal trends in antiplatelet agent selection were illustrated using descriptive statistics segmented by month and quarter. Using logistic regressions with stepwise model selection, factors associated with use of the newer medications, as well as with the selection between ticagrelor and prasugrel, were identified.RESULTS: The analysis included 66,335 subjects. The use of clopidogrel decreased from 100% to roughly 65% of total antiplatelet agent use by the end of 2011 and leveled off thereafter. The introduction of ticagrelor in 2011 coincided with a drop in prasugrel initiation from 35%-18% by December 2013. The use of new agents as opposed to use of clopidogrel was associated with younger age (