Nantsupawat Teerapat, Soontrapa Suthipong, Nantsupawat Nopakoon, Sotello David, Klomjit Saranapoom, Adabag Selcuk, Perez-Verdia Alejandro
Division of Cardiology University of Minnesota Minneapolis MN USA.
Division of Cardiology Texas Tech University Health Sciences Center Lubbock TX USA.
J Arrhythm. 2017 Dec 14;34(1):30-35. doi: 10.1002/joa3.12015. eCollection 2018 Feb.
Dabigatran, as compared with warfarin, was associated with lower rates of stroke and systemic embolism with similar rates of major hemorrhage. But it has a significantly higher risk of gastrointestinal bleeding (GIB). There are limited data on how to prevent GIB from dabigatran and what are the risk factors.
We performed a retrospective cohort study of patients with atrial fibrillation who have ever taken dabigatran for thromboprophylaxis from October 2010 to February 2013.
A total of 247 patients were identified. There were 10 (4%) patients who developed GIB (6 (6.5%) in PPI/H2RA users vs 4 (2.6%) in non-PPI/H2RA users; = .184). History of GIB within 1 year prior to dabigatran initiation and HAS-BLED score ≥3 are independent risk factors for GIB, with odds ratio of 25.14 (95% CI, 2.85-221.47; < .01) and 5.85 (95% CI, 1.31-26.15; = .021), respectively.
In this real-world cohort, PPI/H2RA use was not associated with reduced GIB events. HAS-BLED score ≥3 and prior history of GIB within 1 year are independent risk factors for GIB among dabigatran users.
与华法林相比，达比加群可降低卒中及全身性栓塞发生率，且大出血发生率相似。但它发生胃肠道出血（GIB）的风险显著更高。关于如何预防达比加群所致GIB以及其风险因素的数据有限。
我们对2010年10月至2013年2月期间曾服用达比加群进行血栓预防的房颤患者进行了一项回顾性队列研究。
共纳入247例患者。有10例（4%）患者发生了GIB（使用质子泵抑制剂/组胺H2受体拮抗剂（PPI/H2RA）者6例（6.5%），未使用者4例（2.6%）；P = 0.184）。开始使用达比加群前1年内的GIB病史和HAS - BLED评分≥3是GIB的独立危险因素，比值比分别为25.14（95%可信区间，2.85 - 221.47；P < 0.01）和5.85（95%可信区间，1.31 - 26.15；P = 0.021）。
在这个真实世界队列中，使用PPI/H2RA与GIB事件减少无关。HAS - BLED评分≥3以及开始使用达比加群前1年内的GIB病史是达比加群使用者发生GIB的独立危险因素。
