Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Rheumatology (Oxford). 2020 Sep 1;59(9):2502-2511. doi: 10.1093/rheumatology/kez653.
To evaluate the risk of venous thromboembolism (VTE, i.e. deep vein thrombosis or pulmonary embolism, or both) following new use of NSAIDs in a long-term cohort of U.S. women.
We investigated initiation of coxibs and traditional NSAIDs (excluding aspirin) and incident VTE in 39 876 women enrolled in the Women's Health Study from 1993-95 and followed with yearly questionnaires until 2012. We defined initiation as the first reported use of NSAIDs for ≥4 days per month. Incident VTE was confirmed by an end point committee. We estimated hazard ratios (HRs) and risk differences (RDs, expressed as percentages) comparing NSAID initiation with non-initiation and acetaminophen initiation (active comparator) via standardization using a propensity score that incorporated age, BMI, calendar time, and relevant medical, behavioural, and socioeconomic variables updated over time.
The HR (95% CI) for risk of VTE in the as treated analyses comparing initiation with non-initiation, was 1.5 (1.2, 1.8) for any NSAID, 1.3 (1.1, 1.7) for traditional NSAIDs, and 2.0 (1.3, 3.1) for coxibs, with 2-year RDs 0.11, 0.08 and 0.32, respectively. When comparing the risk of VTE after initiation of any NSAID with that after acetaminophen initiation, the HRs were 0.9 (0.6, 1.5), 0.9 (0.5, 1.5) and 1.4 (0.6, 3.4), with 2-year RDs 0.03, -0.01, and 0.13, respectively.
New use of NSAIDs was associated with increased VTE risk compared with non-use, but the association was null or diminished when compared with acetaminophen initiation. Elevated VTE risks associated with NSAID use in observational studies may in part reflect different baseline risks among individuals who need analgesics and may overstate the risk patients incur compared with pharmacologic alternatives.
在一项美国女性的长期队列研究中，评估新使用非甾体抗炎药（即深静脉血栓形成或肺栓塞，或两者兼有）后静脉血栓栓塞（VTE）的风险。
我们研究了 Coxibs 和传统非甾体抗炎药（不包括阿司匹林）的起始使用以及 1993-95 年参加妇女健康研究的 39876 名女性中的事件性 VTE，并通过每年的问卷调查进行随访，直至 2012 年。我们将起始定义为每月至少有 4 天报告使用 NSAIDs。通过终点委员会确认事件性 VTE。我们通过使用随时间更新的年龄、BMI、日历时间和相关医学、行为和社会经济变量的倾向评分标准化，比较 NSAID 起始与非起始以及乙酰氨基酚起始（活性对照），估算风险比（HRs）和风险差异（RDs，以百分比表示）。
在治疗组分析中，与非起始相比，任何 NSAID 的起始与非起始相比，VTE 的风险 HR（95%CI）为 1.5（1.2，1.8），传统 NSAIDs 为 1.3（1.1，1.7），Coxibs 为 2.0（1.3，3.1），相应的 2 年 RD 分别为 0.11、0.08 和 0.32。与乙酰氨基酚起始后相比，任何 NSAID 起始后 VTE 的风险 HR 分别为 0.9（0.6，1.5）、0.9（0.5，1.5）和 1.4（0.6，3.4），相应的 2 年 RD 分别为 0.03、-0.01 和 0.13。
与非使用相比，新使用 NSAIDs 与 VTE 风险增加相关，但与乙酰氨基酚起始相比，相关性为零或减弱。在观察性研究中，与 NSAID 使用相关的 VTE 风险升高，可能部分反映了需要镇痛剂的个体之间的基线风险不同，并且可能夸大了与药物替代相比患者所承担的风险。
