Harris Crystal L, Raisch Dennis W, Abhyankar Upendra, Marfatia Shalaka, Campbell Heather M, Sather Mike R
Pharmaceutical Management and Research, Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, NM 87106-4180, USA.
Ann Pharmacother. 2006 Nov;40(11):1924-31. doi: 10.1345/aph.1H183. Epub 2006 Oct 17.
Patient characteristics increase the risk of gastrointestinal (GI) complications associated with nonsteroidal antiinflammatory drugs (NSAIDs). Patients at risk may not be prescribed protective therapies that might mitigate their risk of NSAID-associated GI complications.
To assess GI risk among Veterans Affairs (VA) patients on NSAID therapy, determine whether therapy conformed to VA guidelines for lessening the risk of GI complications, and identify patient risk factors associated with conformance.
Using databases from 3 VA medical centers, we retrospectively identified patients receiving NSAIDs and obtained data regarding age, history of GI bleed over 8 years, GI adverse effects associated with NSAIDs, diagnoses, and medication history over one year. We inferred health status from age-adjusted Charlson comorbidity index values. Each patient's risk of developing GI complications over one year was calculated using these data. Among patients at significant or substantial risk, we assessed conformance to VA guidelines. We used logistic regression to identify risk factors associated with conformance and determine adjusted ORs (AORs) with 95% CIs for each risk factor.
There were 19 122 patients receiving NSAIDs. Of 4589 patients at significant risk and 1246 at substantial risk, 1161 (25.3%) and 356 (28.6%), respectively, were prescribed guideline-conformant therapy. Risk factors associated with conformance (p < or = 0.001) among patients at significant risk were rheumatoid arthritis (AOR 1.34; 95% CI 1.13 to 1.58) and GI adverse effects (AOR 1.53; 95% CI 1.42 to 1.64). For substantial risk patients, risk factors associated with conformance (p < or = 0.031) were rheumatoid arthritis (AOR 1.65; 95% CI 1.37 to 1.98), concomitant corticosteroids (AOR 1.21; 95% CI 1.02 to 1.43), GI hospitalization (AOR 2.01; 95% CI 1.57 to 2.59), and GI adverse effects (AOR 1.79; 95% CI 1.47 to 2.18).
Many patients at risk for GI adverse events do not receive guideline-conformant therapy. Educational interventions to improve conformance could focus on specific risk factors for GI complications.
患者特征会增加与非甾体抗炎药（NSAIDs）相关的胃肠道（GI）并发症风险。有风险的患者可能未被开具可减轻其NSAIDs相关GI并发症风险的保护性疗法。
评估接受NSAIDs治疗的退伍军人事务部（VA）患者的GI风险，确定治疗是否符合VA降低GI并发症风险的指南，并识别与符合情况相关的患者风险因素。
利用3个VA医疗中心的数据库，我们回顾性识别接受NSAIDs治疗的患者，并获取有关年龄、8年期间的GI出血史、与NSAIDs相关的GI不良反应、诊断以及1年用药史的数据。我们从年龄调整后的Charlson合并症指数值推断健康状况。使用这些数据计算每位患者1年内发生GI并发症的风险。在具有显著或高度风险的患者中，我们评估其对VA指南的符合情况。我们使用逻辑回归识别与符合情况相关的风险因素，并确定每个风险因素的调整后比值比（AORs）及95%置信区间（CIs）。
有19122名患者接受NSAIDs治疗。在4589名具有显著风险和1246名具有高度风险的患者中，分别有1161名（25.3%）和356名（28.6%）接受了符合指南的治疗。具有显著风险的患者中与符合情况相关的风险因素（p≤0.001）为类风湿性关节炎（AOR 1.34；95% CI 1.13至1.58）和GI不良反应（AOR 1.53；95% CI 1.42至1.64）。对于具有高度风险的患者，与符合情况相关的风险因素（p≤0.031）为类风湿性关节炎（AOR 1.65；95% CI 1.37至1.98）、同时使用皮质类固醇（AOR 1.21；95% CI 1.02至1.43）、GI住院治疗（AOR 2.01；95% CI 1.57至2.
