Premium
Time‐trends in the prescribing of gastroprotective agents to primary care patients initiating low‐dose aspirin or non‐steroidal anti‐inflammatory drugs: a population‐based cohort study
Author(s) -
Warlévan Herwaarden Margaretha F.,
Koffeman Aafke R.,
Valkhoff Vera E.,
’t Jong Geert W.,
Kramers Cornelis,
Sturkenboom Miriam C.,
De Smet Peter A. G. M.
Publication year - 2015
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12626
Subject(s) - medicine , medical prescription , aspirin , cohort , population , cohort study , pharmacy , retrospective cohort study , emergency medicine , family medicine , pharmacology , environmental health
Aims Low‐dose aspirin (LDA) and non‐steroidal‐anti‐inflammatory drugs (NSAIDs) both increase the risk of upper gastrointestinal events (UGIEs). In the Netherlands, recommendations regarding the prescription of gastroprotective agents (GPAs) in LDA users were first issued in 2009 in the HARM‐Wrestling consensus. National guidelines on gastroprotective strategies (GPSs) in NSAID users were issued in the first part of the preceding. The aim of the present study was to examine time‐trends in GPSs in patients initiating LDA and those initiating NSAIDs between 2000 and 2012. Methods Within a large electronic primary healthcare database, two cohorts were selected: (i) patients newly prescribed LDA and (ii) patients newly prescribed NSAIDs between 2000 and 2012. Patients who had been prescribed a GPA in the previous six months were excluded. For both cohorts, patients’ risk of a UGIE was classified as low, moderate or high, based on the HARM‐Wrestling consensus, and the presence of an adequate GPSwas determined. Results A total of 37 578 patients were included in the LDA cohort and 352 025 patients in the NSAID cohort. In both cohorts, an increase in GPSs was observed over time, but prescription of GPAs was lower in the LDA cohort. By 2012, an adequate GPS was present in 31.8% of high‐risk LDA initiators, vs . 48.0% of high‐risk NSAID initiators. Conclusions Despite a comparable risk of UGIEs, GPSs are prescribed less in high‐risk LDA initiators than in high‐risk NSAID initiators. For both groups of patients, there is still room for improvement in guideline adherence.