From the Spanish Centre for Pharmacoepidemiologic Research (CEIFE) (L.C.S., L.A.G.R.), Madrid; Department of Preventive Medicine and Public Health (L.C.S.), Faculty of Medicine, Complutense University of Madrid, Spain; Department of Neurology (D.G.), Odense University Hospital; Department of Clinical Research (D.G.), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Epidemiology (M.S.-G.), Bayer AG, Berlin, Germany; EpiMed Communications Ltd (S.B.), Abingdon, Oxford; and London School of Hygiene and Tropical Medicine (S.B.), UK.
Neurology. 2017 Nov 28;89(22):2280-2287. doi: 10.1212/WNL.0000000000004694. Epub 2017 Nov 1.
To quantify the risk of intracranial bleeds (ICBs) associated with new use of prophylactic low-dose aspirin using a population-based primary care database in the United Kingdom.
A cohort of new users of low-dose aspirin (75-300 mg; n = 199,079) aged 40-84 years and a 1:1 matched cohort of nonusers of low-dose aspirin at baseline were followed (maximum 14 years, median 5.4 years) to identify incident cases of ICB, with validation by manual review of patient records or linkage to hospitalization data. Using 10,000 frequency-matched controls, adjusted rate ratios (RRs) with 95% confidence intervals (CIs) were calculated for current low-dose aspirin use (0-7 days before the index date [ICB date for cases, random date for controls]); reference group was never used.
There were 1,611 cases of ICB (n = 743 for intracerebral hemorrhage [ICH], n = 483 for subdural hematoma [SDH], and n = 385 for subarachnoid hemorrhage [SAH]). RRs (95% CI) were 0.98 (0.84-1.13) for all ICB, 0.98 (0.80-1.20) for ICH, 1.23 (0.95-1.59) for SDH, and 0.77 (0.58-1.01) for SAH. No duration of use or dose-response association was apparent. RRs (95% CI) for ≥1 year of low-dose aspirin use were 0.90 (0.72-1.13) for ICH, 1.20 (0.91-1.57) for SDH, and 0.69 (0.50-0.94) for SAH.
Low-dose aspirin is not associated with an increased risk of any type of ICB and is associated with a significantly decreased risk of SAH when used for ≥1 year.
利用英国基于人群的初级保健数据库，量化新使用低剂量阿司匹林预防颅内出血（ICB）的风险。
在 40-84 岁年龄组中，新使用低剂量阿司匹林（75-300mg；n=199079）的患者队列和基线时不使用低剂量阿司匹林的 1:1 匹配队列，随访（最长 14 年，中位数 5.4 年）以确定 ICB 的病例，通过对患者记录进行人工审查或与住院数据进行链接来进行验证。使用 10000 个频率匹配对照，计算当前低剂量阿司匹林使用（病例的 ICB 日期[索引日期]前 0-7 天，对照的随机日期）的调整后率比（RR）及其 95%置信区间（CI），参考组从未使用过。
共发生 1611 例 ICB（n=743 例为脑出血[ICH]，n=483 例为硬膜下血肿[SDH]，n=385 例为蛛网膜下腔出血[SAH]）。所有 ICB 的 RR（95%CI）为 0.98（0.84-1.13），ICH 为 0.98（0.80-1.20），SDH 为 1.23（0.95-1.59），SAH 为 0.77（0.58-1.01）。未观察到使用时间或剂量-反应关系。低剂量阿司匹林使用≥1 年的 RR（95%CI）为 ICH 为 0.90（0.72-1.13），SDH 为 1.20（0.91-1.57），SAH 为 0.69（0.50-0.94）。
低剂量阿司匹林与任何类型的 ICB 风险增加无关，当使用≥1 年时，与蛛网膜下腔出血风险显著降低相关。
