目的 了解我国住院患者口服抗凝药的使用现状和趋势。方法 自医院处方分析合作项目数据库中,提取2012~2016年中国5城市参与医院住院患者使用口服抗凝药物的处方数据,对各药物的使用人次和金额进行统计和分析。结果 本研究共提取住院患者口服抗凝药处方258 276条。国内使用口服抗凝药的住院患者数逐年增加,主要使用的抗凝药物是华法林,但是其占比逐年下降,而利伐沙班等新型口服抗凝药使用人数增加较快。华法林和新型口服抗凝药在使用人数和金额上呈现不均衡性。口服抗凝药物的选择在不同疾病患者和专科医生中存在不同。结论 口服抗凝药使用人数和金额逐年增长,其中新型口服抗凝药费用高,增长快。需要对口服抗凝药的合理使用引起注意。
Abstract
OBJECTIVE To investigate the trends and current status of oral anticoagulant (OAC) use in hospitalized patients. METHODS OAC prescriptions of inpatients during 2012 to 2016 were extracted from the database of hospital prescription analysis cooperation program. The extracted prescriptions were restricted to hospitals which located in 5 major cities of China. The number of patients and cost of drugs were calculated and analyzed. RESULTS A total of 258 276 prescriptions were extracted. The number of patients using OAC increased every year. Warfarin was the most frequently prescribed OAC, but the portion of warfarin decreased. Non vitamin-K antagonist anticoagulants (NOAC) including rivaroxaban increased rapidly. Imbalance existed between warfarin and NOAC on patient population and cost. The use of OAC differed by indications and specialists. CONCLUSION The number of patients and cost of drugs increased every year while NOAC had taken a large portion of cost. Attention should be payed to the rationality of OAC use.
关键词
华法林 /
利伐沙班 /
达比加群 /
阿哌沙班 /
非维生素K拮抗剂抗凝药
{{custom_keyword}} /
Key words
warfarin /
rivaroxaban /
dabigatran /
apixaban /
non-vitamin K antagonist anticoagulant
{{custom_keyword}} /
中图分类号：
R972
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] CHAMBERLAIN A M, GERSH B J, ALONSO A, et al. Decade-long trends in atrial fibrillation incidence and survival: a community study[J]. Am J Med, 2015, 128(3):260-267.
[2] MORILLO R, JIMÉNEZ D, AIBAR M Á, et al. DVT Management and outcome trends, 2001 to 2014[J]. Chest, 2016,150(2):374-383.
[3] SURI R M, THOURANI V H, HE X, et al. Variation in warfarin thromboprophylaxis after mitral valve repair: does equipoise exist and is a randomized trial warranted?[J]. Ann Thorac Surg, 2013,95(6):1991-1998.
[4] PATEL M R, MAHAFFEY K W, GARG J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J]. N Engl J Med, 2011,365(10):883-891.
[5] AGNELLI G, BULLER H R, COHEN A, et al. Apixaban for extended treatment of venous thromboembolism[J]. N Engl J Med, 2013,368(8):699-708.
[6] GOLDHABER S Z, SCHELLONG S, KAKKAR A, et al. Treatment of acute pulmonary embolism with dabigatran versus warfarin: a pooled analysis of data from RE-COVER and RE-COVER II[J]. Thromb Haemost, 2016,116(4):714-721.
[7] CLAXTON L, TAYLOR M, LEWIS L, et al. Cost-effectiveness of edoxaban compared with other licensed noacs for the prevention of stroke and systemic embolic events in the UK[J]. Value Heal, 2015,18(7):A396.
[8] KREJCZY M, HARENBERG J, MARX S, et al.Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation across countries[J]. J Thromb Thrombolysis,2014,37(4): 507-523.
[9] BARNES G D, LUCAS E, ALEXANDER G C, et al. National trends in ambulatory oral anticoagulant use[J]. Am J Med, 2015, 128(12):1300-1305.
[10] WEITZ J I, SEMCHUK W, TURPIE A G G, et al. Trends in prescribing oral anticoagulantsin canada, 2008-2014[J]. Clin Ther, 2015, 37(11):2506-2514.
[11] VERDECCHIA P, ANGELI F, AITA A, et al. Why switch from warfarin to NOACs?[J].Intern Emerg Med, 2016, 11(3):289-293.
[12] TRUSLER M. Well-managed warfarin is superior to NOACs[J]. Can Fam Physician, 2015, 61(1):23-24.
[13] CONNOLLY S J, EZEKOWITZ M D, YUSUF S, et al. Dabigatran versus warfarin in patients with atrial fibrillation[J]. N Engl J Med, 2009, 361(12):1139-1151.
[14] GRANGER C B, ALEXANDER J H, MCMURRAY J J V, et al. Apixaban versus warfarin in patients with atrial fibrillation[J]. N Engl J Med, 2011, 365(11):981-992.
[15] FALCK-YTTER Y, FRANCIS C W, JOHANSON N A, et al. Prevention of VTE in orthopedic surgery patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 suppl):e278S-e325S.
[16] KEARON C, AKL E A, ORNELA S J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report[J]. Chest, 2016, 149(2):315-352.
[17] DAULT R, VANASSE A, BLAIS L, et al. Patterns and predictors of use of anticoagulants for the treatment of venous thromboembolism following approval of rivaroxaban[J]. Clin Appl Thromb Hemost, 2016, 22(8):765-771.
[18] DI PASQUALE G, ZAGNONI S, RIVA L. Novel oral anticoagulants and valvular atrial fibrillation: are they always contraindicated?[J] Intern Emerg Med, 2015, 10(1):21-24.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
基金
中国健康促进基金会课题——新型口服抗凝药物的发展、评价和利用项目资助
{{custom_fund}}
PDF(1306 KB)
