Abstract:

Objective To analyze the usage rate of clopidogrel in combination with aspirin through big data analysis. Methods Using the Beijing Medical Insurance Database for Employers, patients with the primary diagnosis of ischemic stroke or transient ischemic attack (TIA) and related syndrome from January 1, 2012 to December 31, 2014 were identified as the study subjects and were divided into two subsets according to International Classification of Diseases-10 (ICD), with June, 2013 as the cutoff point. The two subsets both covered 18-month long period. Descriptive analysis was applied to compare the difference in the usage rate of clopidogrel in combination with aspirin between the two subsets. Subgroup analysis was also conducted in ischemic stroke patients and TIA patients separatively. Results A total of 6 296 188 cases and 101 587 subjects were included during study period. During July, 2013 to December, 2014, 876.9 (±129.8) cases used clopidogrel in combination with aspirin each month, accounting for 14.7% of the total cases. And the number was 649.9 (±129.8) from January, 2012 to June, 2013, accounting for 12.3% of the total cases. The usage rates were 14.5% and

9.1% in patients with primary diagnosis as ischemic stroke and TIA each month before June, 2013, respectively. The usage rates became higher after June, 2013 (20.2% and 11.1% for ischemic stroke and TIA, respectively). Before June, 2013, 18.3% of the participants used clopidogrel in combination with aspirin. Afterwards, the proportion rate increased up to 22.2%. Conclusion Among the patients with ischemic stroke and TIA of Beijing Medical Insurance Database, the usage rate of clopidogrel in combination with aspirin after June, 2013 was higher than that of before June, 2013.

Key words: Ischemic stroke; Anti-platelet therapy; Big data

摘要：

目的 通过大数据分析我国临床缺血性卒中患者阿司匹林联合氯吡格雷（双抗）的使用率情况。 方法 从北京市职工医疗保险系统数据库中提取2012年1月-2014年12月，根据国际疾病分类 （International Classification of Diseases，ICD）-10编码主诊断为I63（缺血性卒中）和G45[短暂性脑缺血发 作（transient ischemic attack，TIA）和相关的综合征]的患者，以2013年6月为界限分为前后各18个月，比 较这两个阶段患者用药记录中阿司匹林联合氯吡格雷用药的使用比例。并按照主诊断为缺血性卒中 和TIA进行亚组分析。 结果 研究期间共纳入用药记录6 296 188例次，患者总计101 587例。2013年7月-2014年12月，每个 月双抗使用876.9例次（标准差129.8），中位数867（最小值511、最大值1112），占比14.7%。而2012年1 月-2013年6月每个月的双抗使用649.9例次（标准差129.8），中位数650.5（最小值352、最大值895）， 占比12.3%。2013年6月以后，主诊断为缺血性卒中和TIA的患者每月双抗使用比例分别为20.2%和 11.1%，而2013年6月之前每月双抗的比例为14.5%和9.1%，2013年6月之后的双抗使用比例大于2013 年6月之前。2013年6月前双抗的使用人数占入选患者的18.3%，而2013年6月之后接受双抗治疗的患 者比例提高至22.2%。 结论 在北京市医疗保险缺血性卒中和TIA患者中，相比2013年6月前，2013年6月后使用阿司匹林联 合氯吡格雷进行双抗的比例较高。

关键词: 缺血性卒中; 抗血小板治疗; 大数据