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KMID : 1022920100020010021
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Journal of Korean Academy of Social & Managed Care Pharmacy
2010 Volume.2 No. 1 p.21 ~ p.29
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Analysis of prescribing patterns of oral anti-thrombotics in outpatients - Focusing on prescriptions containing multiple drugs -
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Choi Kyung-Eob
Koh Min-Kyung
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Abstract
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The number of patients with cerebrovascular disease, cardiovascular disease and peripheral arterial disease has recently grown. Accordingly, the prescription of anti-thrombotic agents to prevent or treat those macrovascular diseases has been dramatically increased. The objectives of this study were to investigate the prescribing patterns of oral anti-thrombotic drugs in outpatients and assess the appropriate use of those drugs based on KFDA indications and DUR criteria. Out of 17, 376, 715, only 482 prescriptions were finally selected which they contained both multiple drugs and oral anti-thrombotics. The analysis of the selected prescriptions revealed that 43.4%, 36.0% and 29.0% were coded with cerebrovascular, cardiovascular and peripheral arterial disease, respectively. The average (±SD) number of oral anti-thrombotics per prescription was 1.51 (±0.70). Among the oral anti-thrombotic agents, aspirin (34.2%) was prescribed the most, followed by clopidogrel (23.4%), cilostazol (8.7%), sarpogrelate (8.2%), limaprost (5.9%), triflusal (4.2%), beraprost (4.1%), mesoglycan (3.8%), warfarin (3.3%), sulodexide (1.2%), sulfomucopolysaccharide (1.2%), ticlopidine (1.0%) and indobufen (0.7%), whereas dipyridamole was not prescribed at all. Monotherapy (59.5%) exceeded multiple therapy (40.5%) and the most common combination was aspirin plus clopidogrel. It was found that 27.4% of aspirin containing prescriptions did not have any responsible disease code, suggesting that aspirin was used for primary prevention. In case of limaprost, it was used even more for the treatment of spinal stenosis (69.8%) than peripheral arterial disease (30.2%). As a result of the prescription adjudication, 72.8% of total prescriptions were acknowledged to be appropriate, and the rate of inappropriate use was calculated as follows; sulodexide (78%), beraprost (67%), sarpogrelate (60%), ticlopidine (57%), cilostazol (46%), sulfomucopolysaccharide (44%), triflusal (41%), mesoglycan (39%), clopidogrel (36%), limaprost (23%), indobufen (20%), aspirin(1%) and warfarin (0%). Our findings indicated that aspirin was the most commonly prescribed oral anti-thrombotic agents for preventing or treating macrovascular diseases, and this prescribing patterns corroborated text books and clinical practice guidelines.
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KEYWORD
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anti-thrombotic, macrovascular disease, aspirin, anti-platelet, anti-coagulant
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