비판막성 심방세동을 가진 외래 노인 환자에서 Apixaban 약물 사용 평가
Drug Utilization Evaluation of Apixaban in Older Patients with Non-valvular Atrial Fibrillation in Ambulatory Care
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초록
Apixaban is non-inferior to warfarin in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. The clinical use of apixaban in older patients is carefully regulated by the Health Insurance Review and Assessment Service in South Korea, due to a high bleeding risk. This study aimed to evaluate the patterns of apixaban use and medication adherence. A retrospective study was conducted using the electronic medical record (EMR). The study included patients who were 65 years and older with non-valvular atrial fibrillation who were prescribed apixaban from July 1, 2016, to June 30, 2017, in an ambulatory care setting in the Seoul National University Bundang Hospital. We assessed apixaban usage, concomitant medications, and adverse events based on information from the Ministry of Food and Drug Safety. The medication adherence was calculated by cumulative medication adherence (CMA), with appropriate medication adherence defined as a CMA equal to or higher than 80 percent. Among the 553 eligible patients, 243 patients were excluded because they were prescribed apixaban during hospitalization, baseline data were unavailable, or they were lost to follow-up. A total of 310 patients were analyzed for the study. The mean age was 76.6 years. Of these, 52.6% of patients used low dose apixaban. A total of 309 (99.7%) patients were covered by the National Health Insurance. The rate of concurrent use of antiplatelet therapy was 13.2 percent. Adverse events were reported in 17 (5.5%) patients, and were mostly non-major bleeding events. The appropriate medication adherence rate was 93.2 percent. This study showed that the rates of National Health Insurance coverage and medication adherence were more than 90 percent. In real clinical practice, low doses of apixaban were used more than 50% because of the bleeding risk in older aged patients. Because long-term use of apixaban is prescribed for elderly patients with non-valvular atrial fibrillation, pharmacists must take active roles in counseling and close monitoring of adverse events to improve medication adherence.
Abstract
Apixaban is non-inferior to warfarin in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. The clinical use of apixaban in older patients is carefully regulated by the Health Insurance Review and Assessment Service in South Korea, due to a high bleeding risk. This study aimed to evaluate the patterns of apixaban use and medication adherence. A retrospective study was conducted using the electronic medical record (EMR). The study included patients who were 65 years and older with non-valvular atrial fibrillation who were prescribed apixaban from July 1, 2016, to June 30, 2017, in an ambulatory care setting in the Seoul National University Bundang Hospital. We assessed apixaban usage, concomitant medications, and adverse events based on information from the Ministry of Food and Drug Safety. The medication adherence was calculated by cumulative medication adherence (CMA), with appropriate medication adherence defined as a CMA equal to or higher than 80 percent. Among the 553 eligible patients, 243 patients were excluded because they were prescribed apixaban during hospitalization, baseline data were unavailable, or they were lost to follow-up. A total of 310 patients were analyzed for the study. The mean age was 76.6 years. Of these, 52.6% of patients used low dose apixaban. A total of 309 (99.7%) patients were covered by the National Health Insurance. The rate of concurrent use of antiplatelet therapy was 13.2 percent. Adverse events were reported in 17 (5.5%) patients, and were mostly non-major bleeding events. The appropriate medication adherence rate was 93.2 percent. This study showed that the rates of National Health Insurance coverage and medication adherence were more than 90 percent. In real clinical practice, low doses of apixaban were used more than 50% because of the bleeding risk in older aged patients. Because long-term use of apixaban is prescribed for elderly patients with non-valvular atrial fibrillation, pharmacists must take active roles in counseling and close monitoring of adverse events to improve medication adherence.
참고문헌 (30)
- Halvorsen S, "Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation : observations from the ARISTOTLE trial", Eur Heart J, 35(28), pp.1864~1872 (2014)
- Harrington AR, "Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation", Stroke, 44(6), pp.1676~1681 (2013)
- Holbrook AM, "Systematic overview of warfarin and its drug and food interactions", Arch Intern Med, 165(10), pp.1095~1106 (2005)
- Gage BF, "Management and dosing of warfarin therapy", AmJ Med, 109(6), pp.481~488 (2000)
- "FDA approves Eliquis to reduce the risk of stroke, blood clots in patients with nonvalvular atrial fibrillation"[URL]
- Harder S, "Novel oral anticoagulants : Clinical pharmacology, indications and practical considerations", Eur J Clin Pharmacol, 69(9), pp.1617~1633 (2013)
- Ikeda T, "Use of oral anticoagulants according to the degree of renal impairment in Japanese patients with atrial fibrillationwhich non-vitamin K antagonist oral anticoagulant to select?", Circ J, 79(7), pp.1441~1443 (2015)
- Granger CB, "Apixaban versus warfarin in patients with atrial fibrillation", N Engl J Med, 365(11), pp.981~992 (2011)
- Bristol-Myers Squibb Company, "ELIQUIS (apixaban)", ~ (2016)
- Raghavan N, "Apixaban metabolism and pharmacokinetics after oral administration to humans", Drug Metabolism and Disposition, 37(1), pp.74~81 (2009)
- Halvorsen S, "Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation : observations from the ARISTOTLE trial", Eur Heart J, 35(28), pp.1864~1872 (2014)
- Phillips MS, "American Society of Health-system Pharmacists", Am J Health Syst Pharm, 53(16), pp.1953~1955 (1996)
- 박재현, "우리나라 건강보험 가입자의 고혈압약 투약 순응도와 이에 영향을 미치는 요인", 박사, 의료관리학, pp.2006
- Steiner JF, "The assessment of refill compliance using pharmacy records : Methods, validity, and applications", J Clin Epidemiol, 50(1), pp.105~116 (1997)
- Bahit MC, "Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation", Heart, 103(8), pp.623~628 (2017)
- Yi‐Hsin Chan, "Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation", Journal of the American Heart Association, 7(8) (2018), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Pradhan AA, "Warfarin use in atrial fibrillation : a random sample survey of family physician beliefs and preferences", Can J Clin Pharmacol, 9(4), pp.199~202 (2002)
- Klatsky AL, "Risk of hemorrhagic stroke in Asian American ethnic groups", Neuroepidemiology, 25(1), pp.26~31 (2005)
- Mehta RH, "Race", Ethnic differences in the risk of hemorrhagic complications among patients with ischemic stroke receiving thrombolytic therapy, 2014, pp.45(8), 2263~2269
- Amartya K, "Minimizing the Risk of Bleeding with NOACs in the Elderly", Drugs Aging, 33(7), pp.491~500 (2016)
- Van der Meer FJ, "Bleeding complications in oral anticoagulant therapy. An analysis of risk factors", Arch Intern Med, 153(13), pp.1557~1562 (1993)
- Tse HF, "Stroke prevention in atrial fibrillation--an Asian stroke perspective", Heart Rhythm, 10(7), pp.1082~1088 (2013)
- Alexander JH, "Apixaban with antiplatelet therapy after acute coronary syndrome", N Engl J Med, 365(8), pp.699~708 (2011)
- Jean M Connors, "Antidote for Factor Xa Anticoagulants", N Engl J Med, 373(25), pp.2471~2472 (2015)
- Mekaj YH, "New oral anticoagulants : their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events", Ther Clin Risk Manag, 11, pp.967~ (2015)
- Heidbuchel H, "Updated European Heart Rhythm Association Practical Guide on the use of nonvitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation", Europace, 17(10), pp.1467~1507 (2015)
- 박경호, "약물사용과 Drug Use Review(DUR)", J Korean Soc Hosp Pharm, 13(1), pp.70~77 (1996)
- Bahit MC, "Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation", Heart, 103(8), pp.623~628 (2017)
- Connolly SJ, "Apixaban in patients with atrial fibrillation", N Engl J Med, 364(9), pp.806~817 (2011)
- McHorney CA, "Comparison of Adherence to Rivaroxaban Versus Apixaban Among Patients With Atrial Fibrillation", Clin Ther, 38(11), pp.2477~2488 (2016)