Ann Intern Med. 2014 Nov 18;161(10):690-8. doi: 10.7326/M13-1581.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown.
To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy.
Observational cohort study.
Nationwide registries.
Danish patients with AF hospitalized between 1997 and 2011.
Absolute risk for serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy, assessed by using Cox models.
Of 150 900 patients with AF (median age, 75 years [interquartile range, 65 to 83 years]; 47% female), 53 732 (35.6%) were prescribed an NSAID during a median follow-up of 6.2 years (interquartile range, 2.1 to 14.0 years). There were 17 187 (11.4%) and 19 561 (13.0%) occurrences of serious bleeding and thromboembolism, respectively. At 3 months, the absolute risk for serious bleeding within 14 days of NSAID exposure was 3.5 events per 1000 patients compared with 1.5 events per 1000 patients without NSAID exposure. The risk difference was 1.9 events per 1000 patients. In patients selected for oral anticoagulant therapy, the absolute risk difference was 2.5 events per 1000 patients. Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding.
Observational design and unmeasured confounders.
Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with AF. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with AF.
None.
非甾体抗炎药（NSAIDs）被认为会增加出血风险，但它们与正在接受抗血栓治疗的房颤（AF）患者严重出血的实际关系尚不清楚。
研究持续使用 NSAIDs 和抗血栓药物与严重出血和血栓栓塞风险的关系。
观察性队列研究。
全国性登记处。
1997 年至 2011 年期间住院的丹麦 AF 患者。
使用 Cox 模型评估持续使用 NSAIDs 和抗血栓治疗时严重出血和血栓栓塞的绝对风险。
在 150900 名 AF 患者中（中位年龄 75 岁[四分位间距 65 至 83 岁]；47%为女性），53732 名（35.6%）在中位随访 6.2 年（四分位间距 2.1 至 14.0 年）期间被处方 NSAIDs。分别有 17187（11.4%）和 19561（13.0%）例严重出血和血栓栓塞事件发生。在 NSAID 暴露后 14 天内，3 个月时严重出血的绝对风险为每 1000 例患者 3.5 例，而无 NSAID 暴露的每 1000 例患者为 1.5 例。风险差异为每 1000 例患者 1.9 例。在选择口服抗凝治疗的患者中，绝对风险差异为每 1000 例患者 2.5 例。在所有抗血栓治疗方案和 NSAID 类型中，使用 NSAIDs 均与严重出血和血栓栓塞的绝对风险增加相关。NSAIDs 的剂量超过推荐的最低剂量与出血风险显著增加相关。
观察性设计和未测量的混杂因素。
在 AF 患者中，使用 NSAIDs 与严重出血和血栓栓塞风险独立相关。短期 NSAID 暴露与出血风险增加相关。医生在 AF 患者中使用 NSAIDs 时应谨慎。
无。
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