scholarly journals Prescription patterns of direct oral anticoagulants and concomitant use of interacting medications in the Netherlands

2021 ◽  
Author(s):  
R. E. Harskamp ◽  
J. C. L. Himmelreich ◽  
G. W. M. Wong ◽  
M. Teichert
Keyword(s):  
The Netherlands ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cross Sectional Study ◽  
Eastern Region ◽  
Cross Sectional ◽  
Organ Systems ◽  
Number Of Patients ◽  
Antiarrhythmic Medications ◽  
Over Time

Abstract Objectives To describe the prevalence, temporal and regional trends in prescribing direct oral anticoagulants (DOACs) in conjunction with interacting medications. Methods We performed a cross-sectional study of pharmacy dispensing data in the Foundation for Pharmaceutical Statistics (SFK) registry on patients who have had a prescription for a DOAC filled at one of 831 randomly selected pharmacies in the Netherlands between Jan 2014–Jan 2019. Results We identified 99,211 patients who had a first DOAC prescription filled. Mean age was 71.6 ± 10.9 years, 58% were male. In 2014, 8,293 patients were treated with DOACs, in 2018, 35,415 were newly started on a DOAC. In 2018, the use of apixaban was most common (52%) in the Eastern region, whereas rivaroxaban was most frequently prescribed (32–48%) in the other regions. At time of first prescription, the vast majority (99.3%) used ≥ 1 concomitant interacting drug, and 3.2% used ≥ 3 interacting medications. Most common were digoxin (37.8%), atorvastatin (31.5%), verapamil (13.7%) and amiodarone (9.7%). While the number of interacting medications remained unchanged over time (median 1, interquartile range 1–1), there was a notable decrease in antiarrhythmic medications and an increase in non-cardiovascular interacting medications (e.g. dexamethasone from 0.9% to 7.1%, antiepileptic drugs from 2.5% to 3.8%, and haloperidol from 0.5% to 2.2% in 2014 and 2018, respectively). Conclusion DOAC use has quadrupled in Dutch clinical practice over the 5‑year period from 2014 to 2018. While the number of patients who take interacting medications remained stable, the profile of interacting medications has changed over time from cardiovascular to medications affecting other organ systems.

scholarly journals Screening for anticoagulation undertreatment in more than 100,000 patients with atrial fibrillation in general practices in the Netherlands

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L.J Voorhout ◽  
R Pisters ◽  
C.H.P.H Geurts ◽  
A Oostindjer ◽  
S Van Doorn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
The Netherlands ◽  
Terminal Illness ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Dutch Study ◽  
General Practices

Abstract Background and aim Atrial fibrillation (AF) is associated with a significant morbidity and increased mortality risk, predominantly due to risk of stroke and thromboembolism. Despite availability of highly effective and practical oral anticoagulation (OAC) guidelines recommended therapy is often underutilized. Therefore, we investigated the underuse of OAC in individual AF patients through on-demand screening of general practices (GPs) across the Netherlands. Methods We performed a multi-center, cross-sectional study in 39 GPs. Using electronic patient files, we were able to screen the entire GP population for AF, CHA2DS2-VASc scores, and the use of guidelines recommended OAC. In case of OAC undertreatment we checked for any documented reason. Additionally, six weeks following the screening we asked all GPs to provide information on actions taken for the undertreated patients. Results In total 101,207 patients records were screened identifying 2,375 non-valvular AF patients with a mean CHA2DS2-VASc score of 3.2. OAC use consisted of direct oral anticoagulants in 1,342/1,984 (68%) and vitamin K antagonists in the remainder of patients. OAC undertreatment was present in 92/1001 (9,2%) males and 102/1374 (7,4%) in females, respectively. Figure 1 shows the GP patient population with AF, divided into groups by CHA2DS2-VASc score and their corresponding antithrombotic therapies. Reasons to withhold OAC were patient refusal (n=10), cardiologist advice (n=7), high risk of bleeding (n=7), and terminal illness (n=4). In 159/194 (82%) patients no reason was reported. Data regarding actions following the identification of OAC undertreatment was available in 29 practices representing 92/194 (47%) of the OAC undertreatment cases. After consultation OAC was initiated in 9/92 (10%) only. Conclusions In this large Dutch study among GPs we observe 8.2% undertreatment of OAC in AF patients. More males than females were undertreated as were those with the highest CHA2DS2-VASc scores. Only in a small minority of cases detection of OAC undertreatment lead to OAC initiation. This highlights the need to improve awareness and communication of OAC treatment aimed at preventing strokes. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years

2020 ◽  
Vol 17 (18) ◽  
pp. 6685
Author(s):  
Patrick Manckoundia ◽  
Clémentine Rosay ◽  
Didier Menu ◽  
Valentine Nuss ◽  
Anca-Maria Mihai ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Platelet Aggregation Inhibitors ◽  
Cross Sectional Study ◽  
Very Elderly ◽  
Cross Sectional ◽  
Aggregation Inhibitors ◽  
Cardiovascular Medications

We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.

Self-reported burden in patients with localized prostate cancer treated with stereotactic body radiation therapy (SBRT).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 51-51
Author(s):  
Abigail Pepin ◽  
Nima Aghdam ◽  
Colin Johnson ◽  
Malika Danner ◽  
Marilyn Ayoob ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Localized Prostate Cancer ◽  
Cross Sectional ◽  
Validated Questionnaire ◽  
Number Of Patients ◽  
Over Time

51 Background: Retaining quality of life in patients treated with SBRT for prostate cancer remains paramount. As such, balancing the benefits of treatment against the effects of therapy on patients is essential. The quality of life is influenced by the disease and treatment related burden. The EORTC QLQ-ELD14 (ELD14) is a validated questionnaire that can assess burden. This study reports burden trends in patients with prostate cancer treated with SBRT. Methods: All patients with localized prostate cancer treated with SBRT at Georgetown University Hospital from 2007 to 2016 were eligible for inclusion in this cross-sectional cohort. The ELD14 questionnaire was used to assess self-reported patient quality of life at time points before and following treatment. Initially, 267 patients (Median age of 70) responded to the ELD14 questionnaire. Approximately 30% received ADT. The specific questions reviewed for this study were focused on burden of disease and treatment. The responses to these questions were grouped into three clinically relevant categories (not at all, a little and quite a bit to very much). Results: Number of patients reporting quite a bit or very much burden from prostate cancer declined over time from 13% prior to treatment to 8% at 36 months post-SBRT. This was highest at one month post-SBRT (15%) and resolved to baseline by 6 months. Treatment burden similarly decreased over time from 10% to 3%. Patients treated with androgen deprivation therapy (ADT) experienced greater burden than others. At initial consult, 19% of patients on ADT reported quite a bit or very much burden from their illness. At one month post-SBRT, this had increased to 27% and subsequently decreased to 16% at 36 months. Of those not receiving ADT, 12% reported having quite a bit or very much burden from illness initially, 9% at one month and 6% at 36 months. Conclusions: This cross-sectional study suggests that the burden of clinically localized prostate and its treatment with SBRT improves over time. Increased burden was noted in patients receiving ADT. These findings can inform decision making in improving quality of life for patients with prostate cancer treated with SBRT.

scholarly journals Survey of Knowledge and Attitude of Pharmacists about Direct Oral Anticoagulants: A Cross-Sectional Study

2021 ◽  
Author(s):  
Zahra Vakili ◽  
Fatemeh Heydarpour ◽  
Foroud Shahbazi
Keyword(s):  
Health Care Professionals ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cross Sectional Study ◽  
Demographic Characteristics ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
Knowledge And Attitude ◽  
Different Levels

Background: Direct oral anticoagulants (DOACs) are increasingly used due to fewer side effects, predictable pharmacokinetics, lower potential for drug interactions. Different levels of awareness among health care professionals have been reported. Methods: The main objectives of this study were to investigate the knowledge and attitude of pharmacists about direct oral anticoagulants. The present study was a descriptive cross-sectional study performed in Kermanshah province, Iran. The validated researcher-made questionnaire included questions about demographic characteristics and specialized questions that assessed the knowledge and attitude of pharmacists towards new oral anticoagulants.             Results: Out of 126 pharmacists participating in this study, 67 (53.2%) were male. The mean scores of knowledges and attitude in pharmacists were 64.94±5.84 and 28.62±3.98, respectively. The most common oral anticoagulant with a direct effect dispensed by pharmacists was rivaroxaban (77.4%). There was also a significant relationship between pharmacists' attitudes and their place of activity (P = 0.024). Conclusion: The results of this study showed that pharmacists had an acceptable knowledge and low attitude about DOACs.

scholarly journals Spatial Distribution of COVID-19 in Shahroud, Iran Using GIS

2020 ◽  
Author(s):  
Marjan Ghanbarian ◽  
Sepideh Mahdavi ◽  
Mostafa Enayatrad ◽  
Fariba Zare ◽  
Mostafa MajidNia ◽  
...  
Keyword(s):  
Spatial Distribution ◽  
High Risk ◽  
Geographical Distribution ◽  
Cross Sectional Study ◽  
Disease Spread ◽  
Eastern Region ◽  
Risk Of Infection ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Gis Software

Abstract Background: The highest incidence rate of covid-19 in Iran was reported from Shahroud County. This study was conducted by geographic information systems (GIS) to determine the geographical distribution of Covid-19 in 60 days. Study design: A cross-sectional study Methods: This study was conducted in counties covered by Shahroud University of Medical Sciences, namely Shahroud and Mayami, from February 20, 2020 to April 18, 2020. The GIS can better show the spread of epidemics. This software indicates geographical distribution of disease spread and is very helpful in controlling the epidemics. Therefore, maps of spatial distribution and risk of infection to COVID-19 were prepared in different regions of Shahroud county using Arc-GIS software to better implement health policies. Results: During this sixty-day period, 529 confirmed cases were detected, of which 51% were men and the average age was 55 years. The maps showed high-risk to risk-free regions. Shahroud and Bastam cities were known as the coronavirus hot spots. The eastern region of Shahroud has the highest number of cases but some high risk areas are spread throughout the Shahroud city due to high infectivity of virus. Risk-based time maps indicated a reduction in the risk of infection at the end of the research period due to some mitigation and suppression strategies. Conclusions: Shahroud and Bastam are the most dangerous cities that, the number of patients and dissemination has decreased over time because of tracking definite patients and people in contact with them and implementation of preventive care.

scholarly journals Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041529
Author(s):  
Devin Abrahami ◽  
Emily Gibson McDonald ◽  
Mireille Schnitzer ◽  
Laurent Azoulay
Keyword(s):  
Population Based ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Secondary Outcome ◽  
Clinical Practice Research Datalink ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
The Uk ◽  
Over Time

ObjectiveTo examine proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) prescribing patterns over a 29-year period by quantifying annual prevalence and prescribing intensity over time.DesignPopulation-based cross-sectional study.SettingMore than 700 general practices contributing data to the UK Clinical Practice Research Datalink (CPRD).ParticipantsWithin a cohort of 14 242 329 patients registered in the CPRD, 3 027 383 patients were prescribed at least one PPI or H2RA from 1 January 1990 to 31 December 2018.Primary and secondary outcome measuresAnnual prescription rates were estimated by dividing the number of patients prescribed a PPI or H2RA by the total CPRD population. Change in prescribing intensity (number of prescriptions per year divided by person-years of follow-up) was calculated using negative binomial regression.ResultsFrom 1990 to 2018, 21.3% of the CPRD population was exposed to at least one acid suppressant drug. During that period, PPI prevalence increased from 0.2% to 14.2%, while H2RA prevalence remained low (range: 1.2%–3.4%). Yearly prescribing intensity to PPIs increased during the first 15 years of the study period but remained relatively constant for the remainder of the study period. In contrast, yearly prescribing intensity of H2RAs decreased from 1990 to 2009 but has begun to slightly increase over the past 5 years.ConclusionsWhile PPI prevalence has been increasing over time, its prescribing intensity has recently plateaued. Notwithstanding their efficacy, PPIs are associated with a number of adverse effects not attributed to H2RAs, whose prescribing intensity has begun to increase. Thus, H2RAs remain a valuable treatment option for individuals with gastric conditions.

scholarly journals An estimation of patients at potential risk for drug-induced sexual dysfunction using pharmacy dispensing data

2020 ◽  
Author(s):  
Rineke Gordijn ◽  
Melianthe P J Nicolai ◽  
Henk W Elzevier ◽  
Henk-Jan Guchelaar ◽  
Martina Teichert
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Sexual Dysfunction ◽  
The Netherlands ◽  
Sexual Functioning ◽  
Cross Sectional Study ◽  
Additional Risk Factor ◽  
Drug Induced ◽  
Cross Sectional ◽  
Number Of Patients

Abstract Background and Objectives Adverse drug reactions on sexual functioning (sADRs) may seriously decrease a person’s quality of life. A multitude of diseases and drugs are known risk factors for sexual dysfunction. To inform patients better about these potential effects, more insight is needed on the estimated number of patients at high risk for sADRs and their characteristics. Methods This cross-sectional study estimated the number of patients in the Netherlands who were dispensed drugs with a potential very high risk (&gt;10%) or high risk (1–10%) for sADRs as registered in the Summary of Product Characteristics, the official drug information text in Europe. Results In April 2019, 2.06% of the inhabitants of the Netherlands received drugs with &gt;10% risk for sADRs and 7.76% with 1–10% risk. The majority of these patients had at least one additional risk factor for decreased sexual function such as high age or depression. Almost half of the patients were identified with two or more morbidities influencing sexual functioning. Paroxetine, sertraline and spironolactone were the most dispensed drugs with a potential &gt;10% risk for sADRs. One-third of their first dispenses were not followed by a second dispense, with a higher risk of discontinuation for a decreasing number of morbidities. Conclusion About 1 in 11 inhabitants of the Netherlands was dispensed a drug with a potential high risk for sADRs, often with other risk factors for sexual complaints. Further research is needed whether these users actually experience sADRs, to understand its impact on multimorbid patients and to provide alternatives if needed.

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