| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 95 === Introduction
Although the value of warfarin in preventing thromboembolic events in atrial fibrillation (AF) patients has been well established, the prescribing rate of warfarin was still under expected. The objectives of this study were to evaluate the adherence rate with antithrombotic guideline (ACC/AHA/ ESC 2001) in Taiwan and to identify factors affecting the antithrombotic therapy.
Methods
We included AF patients who were documented with ICD9-CM coded of “42731” twice in non-sampled NHI claim database from 1 July 2003 through 30 June 2004. Utilization of antithrombotic therapy among these patients was analyzed. Univariate and multiple logistic regressions were performed to identify factors associated with antithrombotic therapy and guideline adherence.
Results
Among 39541 AF patients, up to 90% were identified with high risk of thromboembolic events. Only 24.7% of them had received the appropriate antithrombotic therapy. As we had excluded patients with bleeding risk factors, the adherence rate was still 26%. Other than bleeding risk factors, hypertension, coronary heart disease and increased age presented an inverse association with warfarin use. Among physician’s specialty, cardiac surgeons were most likely to adhere to the Guideline, followed by neurologist, cardiologist, other specialist, family physician and other internist. Patients were more likely to receive appropriate antithrombotic therapy when the hospital level was higher.
Conclusion
Most AF patients in Taiwan did not receive appropriated antithrombotic therapy. Patient’s comobidity, physician’s specialty and hospital level all had influenced on the prescription of antithrombotic therapy.
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