Hohmann Natalie, Hohmann Lindsey, Kruse Michael
University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA; Wellaho-Sanitas, Inc., San Diego, CA, USA.
University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA; Wellaho-Sanitas, Inc., San Diego, CA, USA.
Geriatr Nurs. 2014 Jan-Feb;35(1):20-5. doi: 10.1016/j.gerinurse.2013.09.001. Epub 2013 Sep 27.
Use of fall-risk medications (medications that increase risk of falling in the elderly as defined by Beers criteria, STOPP/START criteria, and other literature) or antithrombotics is common in the elderly, and the impact of their concomitant use should be assessed in regards to fall injuries. The primary objective of this study is to assess the simultaneous outpatient use of fall-risk medications and antithrombotics in elderly fall-patients, and secondarily to analyze the injury severity score and occurrence of intracranial hemorrhage.
Consecutive chart review at a level 2 trauma center in California, USA from August 01, 2009 to October 31, 2010. Records included 112 patients at least 65 years of age admitted with an outpatient fall. Fisher's exact and Student's t-tests were used (alpha 0.05, two-tailed) to examine prescribing patterns, intracranial hemorrhage occurrence, and injury severity score. Regression adjusted for antithrombotic and fall-risk medication type and number, opiate use, co-morbidities, age, and gender.
Thirty-nine percent (44/112) of outpatients were prescribed antithrombotics plus fall-risk medications. The mean injury severity score (ISS) was 13.3 (range 1-26, standard deviation 7.2) for patients taking both medication classes versus 9.7 (range 1-25, standard deviation 7.5) for patients taking antithrombotics alone (p = 0.027). Additionally, in patients over 80 years of age, intracranial hemorrhage occurred more frequently with the use of antithrombotics plus fall-risk medications versus antithrombotics alone (18/29 = 62.1% versus 7/24 = 29.2%, p = 0.027, odds ratio = 3.974, 95% confidence interval = 1.094-15.010). Multivariate analyses showed an independent relationship between intracranial hemorrhage occurrence and type of therapy, as well as injury severity score and simultaneous therapy with fall-risk medications and antithrombotics.
Simultaneous prescribing of antithrombotics and fall-risk medications is common. For outpatients over 80 years of age, the odds of experiencing a post-fall intracranial hemorrhage are 4 times higher when prescribed antithrombotics plus fall-risk medications compared to antithrombotics alone, and injury severity is higher with combined use of these medication classes.
使用跌倒风险药物（根据Beers标准、STOPP/START标准及其他文献定义，会增加老年人跌倒风险的药物）或抗血栓药物在老年人中很常见，应评估它们同时使用对跌倒损伤的影响。本研究的主要目的是评估老年跌倒患者同时门诊使用跌倒风险药物和抗血栓药物的情况，其次是分析损伤严重程度评分及颅内出血的发生率。
在美国加利福尼亚州一家二级创伤中心对2009年8月1日至2010年10月31日期间的病历进行连续回顾。记录包括112名至少65岁的门诊跌倒入院患者。使用Fisher精确检验和学生t检验（α = 0.05，双侧）来检查用药模式、颅内出血发生率和损伤严重程度评分。对回归进行调整，以考虑抗血栓药物和跌倒风险药物的类型及数量、阿片类药物使用情况、合并症、年龄和性别。
39%（44/112）的门诊患者同时开具了抗血栓药物和跌倒风险药物。同时服用这两类药物的患者平均损伤严重程度评分（ISS）为13.3（范围1 - 26，标准差7.2），而仅服用抗血栓药物的患者为9.7（范围1 - 25，标准差7.5）（p = 0.027）。此外，在80岁以上的患者中，同时使用抗血栓药物和跌倒风险药物时颅内出血的发生率高于仅使用抗血栓药物（18/29 = 62.1% 对比7/24 = 29.2%，p = 0.027，比值比 = 3.974，95%置信区间 = 1.094 - 15.010）。多变量分析显示颅内出血发生率与治疗类型之间存在独立关系，以及损伤严重程度评分与同时使用跌倒风险药物和抗血栓药物之间存在独立关系。
同时开具抗血栓药物和跌倒风险药物的情况很常见。对于80岁以上的门诊患者，开具抗血栓药物加跌倒风险药物时跌倒后发生颅内出血的几率比仅开具抗血栓药物时高4倍，并且同时使用这两类药物时损伤严重程度更高。
