Using Association Rules to Determine the Concomitant Prescribing Pattern of Antimicrobials and Non-Steroidal Anti-Inflammatory Drugs in Combination with Warfarin
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Abstract
Objective: To report prescribing rates for warfarin in combination with drug classes of interest with potential drug interactions, i.e., antimicrobial or non-steroidal anti-inflammatory drugs (NSAIDs), and to report association rules on the prescribing of such drugs. Methods: The study collected outpatient prescribing data with warfarin from 2016 to 2019 (3 years duration). Drug classes of interest were those interacting with warfarin at the highest severity, and having the strongest level of empirical evidence according to the definition of the Micromedex. The study employed the Apriori algorithm to determine prescribing rates of interested drug combinations by calculating support, confidence, and lift in each association rule. The reports were divided into two types: 1) drug classification into 3 groups, namely antimicrobial agents, NSAIDs, and warfarin, and 2) individual drug reporting. Results: In a classification of drugs into 3 groups, the determination of prescribing rate (% support: S) and confidence of prescribing drug combinations of interest (% confidence: C) based on association rule involving warfarin found three patterns of association rule including concomitant prescribing of antimicrobials and warfarin (S=0.7318%, C=16.00%), concomitant prescribing of NSAIDs with warfarin (S=0.2866%, C=13.67%), and concomitant prescribing for all three groups (S=0.0114 %, C=23.08%). If classified based on individual drugs, a total of 35 patterns of association rules were identified. However, the majority of association rules showed a lift value of less than 1, implying that the association rules were independent or prescribing of one drug was independent of another. Conclusion: Even though the support value of concomitant prescribing was not high, a number of patients were treated with antimicrobial and/or NSAIDs plus warfarin with relatively high confidence. To reduce the risk of adverse effects from drug interactions, there should be appropriate interventions in each drug involved in drug interactions.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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