- 期刊
Prescription Pattern and Reason of De-escalation Strategies of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome
急性冠心症族群使用雙重抗血小板藥物之降階治療處方型態與原因分析
摘要
Objective: Aspirin plus ticgrelor has been the first-line combination of dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). Despite the proven efficacy of ticagrelor, it may come with a higher risk of bleeding, although de-escalation strategies have been proposed to address this problem. Real-world studies of de-escalation have been conflicting, however, and some have only evaluated specific treatment or populations. Our study aimed to investigate the DAPT prescription pattern and reason of de-escalation strategies. Methods: A retrospective cohort study was conducted between January 2015 and December 2021. Data were extracted from the Kaohsiung Medical University Hospital Research Database (KMUHRD). The study mainly discusses the prescription patterns and reasons including prevalence of de-escalation, timing of de-escalation, possible reasons of de-escalation and factors affecting de-escalation strategies. Results: From 2015 to 2021, a total of 1,500 patients with newly diagnosed of ACS started with aspirin plus ticagrelor were enrolled. A total of 589 patients were in the non-switched group and 911 were in the de-escalation group. The prevalence of de-escalation strategies was 60.7%, 62% of de-escalation strategies occurred during the outpatient period. The timing of de-escalation mostly occurred within one month and nine months after the diagnosis of ACS. Possible reasons for de-escalation included bleeding, the use of hemostatics, proton-pump inhibitors (PPI) and oral anticoagulants. Patients older than 65 years (Odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.13-1.84, p = 0.004) and female (OR = 0.69, 95% CI: 0.52-0.93, p = 0.014) were more likely to receive de-escalation. Conclusion: De-escalation strategies are commonly used in Taiwan with reasons mainly related to bleeding events and regulations of health insurance also affecting its use.
並列摘要
目的：Aspirin合併ticagrelor已成為治療急性冠心症之雙重抗血小板藥物的一線組合，儘管ticagrelor的療效已被證實，但它可能帶來更高的出血風險，因此，降階治療被提出來應對此問題。然而，有關降階治療在真實世界的相關研究結果存在著分歧，其中一些研究僅評估特定的降階治療模式或族群。本研究目的在於評估雙重抗血小板藥物之降階治療在急性冠心症族群中的處方型態與降階原因分析。方法：本研究為回顧性世代研究，研究期間為2015年1月至2021年12月，資料來源為高醫體系醫院研究資料庫。本研究主要討論降階治療的處方型態，包括降階治療的盛行率、降階治療時間點、降階治療可能原因，以及影響降階治療之因素。結果：2015年至2021年間，總共收錄1,500名新診斷為急性冠心症且以aspirin合併ticagrelor作為起始治療之患者，未降階組共589人，降階組911人，降階治療的盛行率為60.7%，62%降階治療發生於門診期間。降階治療的時間點主要發生在診斷急性冠心症後的一個月內和九個月後。降階的可能原因包括有出血相關診斷、使用止血藥、氫離子幫浦阻斷劑或口服抗凝血劑。本研究還發現65歲以上（odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.13-1.84, p = 0.004）和女性（OR = 0.69, 95% CI: 0.52-0.93, p = 0.014）更容易接受到降階治療。結論：降階治療在臨床上是普遍在進行的，發生的原因主要和出血相關事件有關，此外，健保政策也可能影響降階治療的使用。