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[大学生论坛]:抗凝血剂

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lahuanjin 发表于 2017-12-30 20:12:18 | 显示全部楼层 |阅读模式
Abstract
摘要

Importance  
Non–vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk.
重要性
非维生素K口服抗凝剂通常会与使用相同代谢途径的其他药品一同服用会增加血尿的风险


Objective  
To assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation.
目标
评价在同时和非同时进行治疗时使用口服抗凝药物时和非瓣膜心房纤维化病人流血主症风险之间的联系。


Design, Setting, and Participants  
Retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016.
实验组设计,设置和参与者
回顾队列研究使用的资料来自于台湾国家健康保险数据库,资料中所包含的91330名非瓣膜心房纤维化病人至少接受了达比加群,利伐沙班或者是阿哌沙班抗凝药物的治疗。调查过程从201211日,经20161231日,到最后的随访日期20161231日。

Exposures
NOAC with or without concurrent use of atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin.
曝光量
同时或非同时使用阿托伐他汀;地高辛;维拉帕米;地尔硫卓;胺碘酮;氟康唑;酮康唑、伊曲康唑、伏立康唑和泊沙康唑;环孢素;红霉素或克拉霉素;决奈达隆;利福平;或苯妥英等抗凝药物。


Main Outcomes and Measures  
Major bleeding, defined as hospitalization or emergency department visit with a primary diagnosis of intracranial hemorrhage or gastrointestinal, urogenital, or other bleeding. Adjusted incidence rate differences between person-quarters (exposure time for each person during each quarter of the calendar year) of NOAC with or without concurrent medications were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score.
主要结果和方法
主要出血,定义为住院或急诊科就诊,主要诊断为颅内出血或胃肠道、泌尿生殖道或其他出血。使用泊松回归和使用倾向分数处理权的逆概率测算有无并发药物的抗凝药物的个人季度(每一年每一季度每人的曝光时间)之间的可调整发生率差异  


Results  
Among 91 330 patients with nonvalvular atrial fibrillation (mean age, 74.7 years [SD, 10.8]; men, 55.8%; NOAC exposure: dabigatran, 45 347 patients; rivaroxaban, 54 006 patients; and apixaban, 12 886 patients), 4770 major bleeding events occurred during 447 037 person-quarters with NOAC prescriptions.The most common medications co-prescribed with NOACs over all person-quarters were atorvastatin (27.6%), diltiazem (22.7%), digoxin (22.5%), and amiodarone (21.1%). Concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in adjusted incidence rates per 1000 person-years of major bleeding than NOACs alone: 38.09 for NOAC use alone vs 52.04 for amiodarone (difference, 13.94 [99% CI, 9.76-18.13]); 102.77 for NOAC use alone vs 241.92 for fluconazole (difference, 138.46 [99% CI, 80.96-195.97]); 65.66 for NOAC use alone vs 103.14 for rifampin (difference, 36.90 [99% CI, 1.59-72.22); and 56.07 for NOAC use alone vs 108.52 for phenytoin (difference, 52.31 [99% CI, 32.18-72.44]; P < .01 for all comparisons). Compared with NOAC use alone, the adjusted incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone.
结果
在91330名患有非瓣膜心房纤维化病人中(平均年龄74.7[SD, 10.8],男性占55.8%NOAC曝光:达比加群,45347例;利伐沙班,54006例;和阿哌沙班,12886例)与抗凝药物搭配最常见的处方药为阿托伐他汀(27.6%),地尔硫卓(22.7%),地高辛(22.5 %)和胺碘酮(21.1%)。在使用抗凝药物时使用胺碘酮、氟康唑、利福平、苯妥英在每年每1000人中出血的可调整发生率与单使用抗凝药物相比也有显著上升:38.09单使用抗凝药物比52.04并用胺碘酮(差数, 13.94 [99% CI, 9.76-18.13]);102.77单使用抗凝药物比241.92并用氟康唑(差数, 138.46 [99% CI, 80.96-195.97]);65.66单使用抗凝药物比103.14并用利福平(差数, 36.90 [99% CI, 1.59-72.22);56.07单使用抗凝药物比108.52并用苯妥英(差数, 52.31 [99% CI, 32.18-72.44]; P < .01 对于所有对照).与单使用抗凝药物相比,主出血的可调整发生率对于同时使用阿托伐他汀、地高辛、红霉素或克拉霉素有显著下降,同时与同时使用维拉帕米;地尔硫卓;环孢素;酮康唑,伊曲康唑,伏立康唑,泊沙康唑和决奈达隆并无显著区别。


Conclusions and Relevance  
Among patients taking NOACs for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding. Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs.
实验结论和相关结论
在服用抗凝药物的同时服用胺碘酮,氟康唑,利福平,苯妥英非瓣膜心房纤维化病人与只服用抗凝药物的病人相比更容易出血。医生在进行抗凝药物治疗的同时应该注意与其他药物一起使用时所面临的风险。

14级商务英语晋洁3141204029

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