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| 研究生： |
王瑞賢 Wang, Jui-Hsien |
|---|---|
| 論文名稱： |
周邊動脈疾病合併慢性腎臟病患者使用抗血栓藥物的處方分析 Utilization pattern of anti-thrombotic agents in Peripheral Artery Disease (PAD) patients with Chronic Kidney Disease (CKD)： A nationwide retrospective cohort Study |
| 指導教授： |
鄭靜蘭
Cheng, Ching-Lan |
| 學位類別： |
碩士 Master |
| 系所名稱： |
醫學院 - 臨床藥學與藥物科技研究所 Institute of Clinical Pharmacy and Pharmaceutical sciences |
| 論文出版年： | 2021 |
| 畢業學年度： | 109 |
| 語文別： | 中文 |
| 論文頁數： | 142 |
| 中文關鍵詞： | 周邊動脈硬化疾病 、慢性腎臟疾病 、處方型態 、健保資料庫回溯型分析 |
| 外文關鍵詞： | Peripheral artery disease, Chronic kidney disease, Prescribing pattern, Nationwide retrospective cohort study |
| 相關次數： | 點閱：148 下載：19 |
| 分享至: |
| 查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
研究背景:
周邊動脈疾病 (peripheral artery disease, PAD)在全球的盛行率逐年攀升。研究指出，病人隨著eGFR (estimated glomerular filtration rate)的下降，慢性腎臟疾病 (Chronic kidney disease, CKD)患者新發生PAD的風險也有增加的趨勢，目前治療指引對於CKD患者發生PAD的建議仍未明確，而台灣此族群患者如何被處置目前仍未知。
研究目的:
透過台灣健保資料庫的觀察性研究，分析加入末期腎臟病前期之病人照護與衛教計畫 (pre-ESRD program)新發生PAD的病人使用抗血栓藥物的處方型態與主要出血事件。
研究方法:
本研究採用回溯性世代研究，資料來源為2011-2018年的健保資料。研究對象為2012-2017年加入pre-ESRD program新診斷PAD的患者，且新診斷後3個月內有使用任一種抗血栓藥物治療，並定義處方開立日為指標日期。以指標日期分析台灣CKD合併PAD病患處方4種抗血栓藥物型態、影響PAD患者處方抗血栓種類的影響因子以及使用不同種抗血栓藥一年內的主要出血事件。本主要出血事件包含顱內出血、腸胃道出血及其他關鍵部位出血，以單用一種抗血小板組當作參考組別，利用COX proportional hazard models計算各組主要出血事件的新發生率 (incidence rate)、HR ratio。
研究結果:
本研究總共納入了2,573名病患，平均年齡為71.91歲，(標準差11.7歲)。
台灣PAD合併CKD患者的處方型態，主要以單用一種抗血小板組最多，佔了70%，其次為合併抗血小板組佔24%、單用一種抗凝血劑組佔4%及抗血小板合併抗凝劑組佔2%。和單用一種抗血小板組比較，若病患有心房顫動、靜脈栓塞者會較傾向單用一種抗凝血劑組，高血壓、糖尿病、心衰竭、急性心肌梗塞者較會使用合併抗血小板組，有心房顫動、靜脈栓塞、缺血性中風者會較傾向使用抗血小板合併抗凝血劑組。
主要出血事件部分，和單用一種抗血小板組相比，單用一種抗凝血劑組與合併抗血小板組有顯著較高的主要出血風險，校正後HR分別為1.417 (95% CI：1.048-1.917) 和1.220 (95% CI：1.064-1.398)，但在抗血小板合併抗凝血劑組雖然發生機率較高 (1.027 ; 95% CI (0.688-1.533))但未達統計顯著性差異。
結論:
台灣CKD合併PAD病人的處方型態以單用一種抗血小板為主。和單用一種抗血小板組別相比，單用一種抗凝血劑組和合併抗血小板組有顯著較高的主要出血風險。
Objective：
To evaluate prescribing pattern of peripheral artery disease (PAD) patients with chronic kidney disease (CKD) in Taiwan and the bleeding risk among different antithrombotic regimens.
Methods：
We conducted a retrospective cohort study using the Taiwan’s National Health Insurance Database (NHID) from 2011-2018 and selected adult (≧20 years old) who enrolled into pre-end stage renal disease program (Pre-ESRD program) with newly PAD diagnosis in the program and prescribed antithrombotic agents within 3 months after newly PAD diagnosis. The date of antithrombotic drugs was defined as index date. We grouped them based on which antithrombotic agents they used at index date and follow-up until 1 year to estimate the major bleeding event. We use intention-to treat (ITT) analysis and cox proportional hazard model to estimate the major bleeding risk between different antithrombotic regimens compared with single antiplatelet.
Results：
We identified 2,573 PAD patients with CKD. The most prescribing medication was single antiplatelet (70%), followed by antiplatelet combination (24%), single anticoagulants (4%) and antiplatelet plus anticoagulant (2%). Patients with atrial fibrillation (AF) and venous thromboembolism (VTE) prefer to use single anticoagulant than single antiplatelet. Physician preferred to prescribe antiplatelet combination to patients with hypertension, diabetes, heart failure and acute myocardial infarction. Patients with AF, VTE, and ischemic stroke had a tendency to use antiplatelet plus anticoagulant treatment. Our results showed that both single anticoagulant and antiplatelet combination treatment have a significantly higher major bleeding risk than single antiplatelet therapy (adjust HR：1.417, (95% CI (1.048-1.917)) and 1.220, (95%CI (1.064-1.398)), respectively.)
Conclusion：
The findings indicated that prescribing pattern among PAD patients with CKD in Taiwan is mainly composed of single antiplatelet treatment. Patient characteristics influence the prescribing pattern. Additionally, single anticoagulant or antiplatelet combination users were associated with significantly higher major bleeding risk than single antiplatelet group.
Key word：
Peripheral artery disease、Chronic kidney disease、Prescribing pattern、nationwide cohort study
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校內：2022-07-01公開校外：2022-07-01公開