title: Concurrent use of antiplatelets, anticoagulants, or digoxin with Chinese medications: a population-based cohort study.
abstract: OBJECTIVE
  We examined the extent of concurrent use of antiplatelets, anticoagulants, or digoxin with Chinese medications (CMs) and identified its associated factors.
  
  
  METHODS
  A retrospective cohort study was conducted using one million random samples from the Longitudinal Health Insurance Database 2005 in Taiwan. High-risk Western medications (HRWMs) focused on in this study were antiplatelets (aspirin, clopidogrel, dipyridamole, ticlopidine), anticoagulants (heparin, warfarin), and digoxin. Concurrent use was described as having an overlapping use period of HRWM with CMs any time in 2005. Baseline demographics, comorbidities, and health service utilizations between patients with and without concurrent HRWM-CM use were compared. Logistic regression analyses were performed to identify factors associated with incident concurrent use.
  
  
  RESULTS
  Of the 70,698 eligible HRWM users, 13.2 % used CMs concurrently for an average duration of 26.7 ± 43 days. The incidence of concurrent HRWM-CM use, which excluded prior CM use within 6 months preceding the first CM use, was 6.3 %. Warfarin or ticlopidine users were more likely to be prescribed with CMs than were the other HRWM users. Factors associated with an increasing incidence of concurrent HRWM-CM use included female sex, age 45-54 years, middle monthly income, higher number of outpatient visits or distinct prescribed medications, and a previous diagnosis of heart diseases, stroke, or hypertension. In contrast, age ≥ 65 years and higher medical expenditure were associated with a lower incidence of concurrent use.
  
  
  CONCLUSIONS
  In the Taiwanese population, approximately one in eight HRWM users were concomitantly prescribed CMs. Whether such concurrent use is associated with adverse clinical outcomes warrants further investigations.
authors.affiliation: School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, No. 91 Hsueh-Shih road, Taichung, Taiwan 40402, Republic of China.
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Tsai
authors.forename: Hsiang-Wen
authors.initials: HW
authors.lastname: Lin
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use*; D004363:Drug Utilization; D017723:Drug Utilization Review; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D041743:Herb-Drug Interactions; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D002316:Cardiotonic Agents; D004365:Drugs, Chinese Herbal; D010975:Platelet Aggregation Inhibitors; D004077:Digoxin