Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
J Am Geriatr Soc. 2019 Mar;67(3):463-470. doi: 10.1111/jgs.15712. Epub 2018 Dec 11.
Although polypharmacy is associated with a negative clinical outcome in various settings and commonly observed in patients receiving oral anticoagulation therapy, evidence on the relevance for the clinical outcome of anticoagulated patients is currently limited. The aim of the study was to investigate the effect of polypharmacy on the clinical outcomes among patients taking phenprocoumon.
Prospective cohort study.
Regular medical care.
Information on 2011 individuals receiving vitamin K antagonists was available for analysis from the prospective multicenter thrombEVAL study.
Data were obtained from clinical visits, computer-assisted interviews, and laboratory measurements. Information on clinical outcome was obtained during a 3-year follow-up period and subsequently validated via medical records.
The prevalence of polypharmacy (five drugs or more) was 84.1% (n = 1691). Quality of anticoagulation therapy assessed by time in therapeutic range was lower in individuals on five to eight drugs and nine drugs or more (70.7% and 64.7%, respectively) compared with subjects without polypharmacy (73.4%). In addition, a significantly higher variability of international normalized ratio measurements was found in the presence of polypharmacy. The cumulative incidence of bleeding, hospitalization, and all-cause mortality, but not for thromboembolic events, increased across groups of medication. In adjusted Cox regression analysis, polypharmacy is an independent risk factor for bleeding (hazard ratio [HR] = 1.62; 95% confidence interval [CI] = 1.04-2.52; p = .033); hospitalization (HR = 1.60; 95% CI = 1.26-2.03; p < .001; and all-cause mortality (HR = 2.16; 95% CI = 1.43-3.27; p < .001) in a dose-dependent relationship. Per additional drug, bleeding risk was increased by 4%.
Polypharmacy influences the quality of anticoagulation therapy and translates into an elevated risk of adverse events in anticoagulated patients. This suggests that additional medication intake in such patients should be critically reviewed by physicians, and it highlights the importance of initiating investigations aimed at reducing multiple medication intake. J Am Geriatr Soc 67:463-470, 2019.
尽管多种药物治疗与各种情况下的负面临床结局相关，并且在接受口服抗凝治疗的患者中也很常见，但目前有关抗凝治疗患者临床结局相关性的证据有限。本研究旨在调查华法林抗凝治疗患者中多种药物治疗对临床结局的影响。
前瞻性队列研究。
常规医疗护理。
来自前瞻性多中心 thrombEVAL 研究的 2011 名接受维生素 K 拮抗剂治疗的患者信息可用于分析。
数据来自临床就诊、计算机辅助访谈和实验室检测。在 3 年随访期间获得临床结局信息，随后通过病历进行验证。
（n=1691）患者中 84.1%存在多种药物治疗（五种或更多药物）。五种至八种药物和九种或更多药物治疗者的治疗范围内时间评估的抗凝治疗质量较低（分别为 70.7%和 64.7%），而无多种药物治疗者的治疗质量较高（73.4%）。此外，存在多种药物治疗时国际标准化比值测量的变异性显著增加。出血、住院和全因死亡率的累积发生率随着药物数量的增加而增加，但血栓栓塞事件发生率无此变化。多因素 Cox 回归分析显示，多种药物治疗是出血（危险比 [HR]=1.62；95%置信区间 [CI]=1.04-2.52；p=0.033）、住院（HR=1.60；95%CI=1.26-2.03；p<0.001）和全因死亡（HR=2.16；95%CI=1.43-3.27；p<0.001）的独立危险因素，呈剂量依赖性。每增加一种药物，出血风险增加 4%。
多种药物治疗影响抗凝治疗质量，并使抗凝治疗患者的不良事件风险增加。这表明，应仔细审查此类患者的额外药物摄入，同时强调开展减少多种药物摄入调查的重要性。美国老年学会杂志 67:463-470,2019。
