STOPP/START Anti-aggregation and Anticoagulation Alerts in Atrial Fibrillation.

IF 2.8 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Current vascular pharmacology Pub Date : 2023-01-01 DOI:10.2174/1570161121666230418163016

Francesco Salis, Antonella Palimodde, Samuele Rundeddu, Antonella Mandas

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引用次数: 5

Abstract

Background: Atrial Fibrillation (AF) is common in the elderly. A key component of AF management is Oral Anticoagulant Therapy (OAT), consisting of Vitamin K Antagonists (VKAs) or Direct Oral Anticoagulants (DOACs). The aim of the present study is to check, using STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) Criteria, if such drugs are potentially inappropriately prescribed/omitted in an elderly population with AF, and to determine their impact on mortality.

Methods: This study included patients (n = 427) with nonvalvular AF consecutively evaluated between 2013 and 2019 at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy, and followed up for 36 months. The OAT group included 330 patients; the other 97 patients constituted the non-OAT group. The sample was assessed for STOPP/START criteria.

Results: We found no difference (p > 0.1) in comorbidity burden, frailty, and cardio-cerebro-vascular disease prevalence in the two groups, which also did not present a difference in 36-month mortality (p = 0.97). OAT was overall appropriately taken, and 62.4% of OAT-group presented the START criterion to take antiplatelets but also the STOPP criterion not to take them, because of the simultaneous anticoagulant intake. In the non-OAT group, 69.1% presented the START criterion to take anticoagulants, and 21.6% the START criterion to take antiplatelets.

Conclusion: Patients with AF are often prone to under or over-prescription, particularly of antithrombotic drugs. The STOPP/START criteria are a valid tool to assess and correct wrong therapeutic choices. In frail and comorbid subjects, survival is not correlated with the assumption of OAT.

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房颤的STOPP/START抗聚集和抗凝警报。

背景:房颤(AF)在老年人中很常见。房颤治疗的一个关键组成部分是口服抗凝治疗(OAT)，包括维生素K拮抗剂(VKAs)或直接口服抗凝剂(DOACs)。本研究的目的是使用STOPP(老年人处方筛选工具)/START(提醒正确治疗筛选工具)标准来检查这些药物在老年房颤人群中是否可能不适当地开处方/遗漏，并确定其对死亡率的影响。方法:本研究纳入2013年至2019年在意大利卡利亚里蒙塞拉托大学医院老年门诊连续评估的非瓣膜性房颤患者(n = 427)，随访36个月。OAT组包括330例患者;其余97例为非oat组。对样品进行STOPP/START标准评估。结果:我们发现两组在合并症负担、虚弱和心脑血管疾病患病率方面没有差异(p > 0.1)， 36个月死亡率也没有差异(p = 0.97)。OAT组患者总体用药合理，62.4%的患者出现了服用抗血小板药物的START标准，但由于同时服用抗凝剂，出现了不服用抗血小板药物的STOPP标准。在非oat组中，69.1%的患者有START标准服用抗凝药物，21.6%的患者有START标准服用抗血小板药物。结论:房颤患者容易处方不足或过量，尤其是抗血栓药物。STOPP/START标准是评估和纠正错误治疗选择的有效工具。在虚弱和合并症的受试者中，生存率与OAT假设无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current vascular pharmacology 医学-外周血管病

CiteScore

9.20

自引率

4.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Vascular Pharmacology publishes clinical and research-based reviews/mini-reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research. Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).