药物使用与尖端扭转型室性心动过速心律失常在瑞典：一项全国范围基于登记的队列研究。
Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study.
机构信息
Department of Analysis, Swedish National Board of Health and Welfare, Stockholm, Sweden.
Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden.
出版信息
BMJ Open. 2020 Mar 12;10(3):e034560. doi: 10.1136/bmjopen-2019-034560.
OBJECTIVE
To study the occurrence of torsades de pointes (TdP) ventricular tachycardia in relation to use of drugs labelled with TdP risk, using two nationwide Swedish registers.
DESIGN
Prospective register-based cohort study.
SETTING
Entire Sweden.
PARTICIPANTS
Persons aged ≥18 years prescribed and dispensed any drug classified with TdP risk during 2006-2017, according to CredibleMeds. Persons with a registered TdP diagnosis during the study period, using drugs labelled with known (TdP 1), possible (TdP 2) or conditional (TdP 3) risk at the incident of TdP were examined.
PRIMARY OUTCOME MEASURES
Occurrence of TdP in relation to exposure rates for individual drugs with TdP risk.
SECONDARY OUTCOME MEASURES
Concurrent use of more than one TdP-labelled drug in a person with a TdP diagnosis.
RESULTS
During the study period, 410 TdP cases using drugs with TdP risk labels at the incident were registered; 205 women and 205 men, mean age 74.0 and 71.5 years, respectively. Antidepressants dominated (129/410, 30%), followed by antiarrhythmics (17%). Diuretics and gastric acid-secretion inhibitors, with TdP risk related to induction of hypokalaemia or hypomagnesaemia, were used in 56% and 32% of the 410 TdP cases, respectively. Among the most used antidepressants, citalopram with known TdP 1 risk was associated with both a higher absolute number and incidence of TdP per 100 000 users (two to four times), compared with mirtazapine with possible (TdP 2), and sertraline with conditional (TdP 3) risk. Multiple risk factors, including advanced age, cardiovascular disease and treatment with more than one TdP-classified drug, were frequently observed.
CONCLUSIONS
Antidepressants followed by antiarrhythmics dominated among TdP risk drugs used by adults with TdP diagnosis, the majority being ≥65 years. TdP risk class and concomitant medication should be considered when prescribing antidepressants to older patients.
目的
使用两个瑞典全国性登记处，研究与使用带有尖端扭转型室性心动过速（TdP）风险标签的药物相关的 TdP 室性心动过速的发生情况。
设计
前瞻性登记处为基础的队列研究。
设置
整个瑞典。
参与者
2006 年至 2017 年期间，根据可信药物（CredibleMeds），年龄≥18 岁的开处方和配药的任何被归类为 TdP 风险药物的人。在研究期间，有 TdP 诊断记录，在 TdP 发生时使用已知（TdP1）、可能（TdP2）或有条件（TdP3）风险标签的药物的人进行了检查。
主要结局指标
与个体 TdP 风险药物的暴露率相关的 TdP 发生情况。
次要结局指标
在 TdP 诊断患者中同时使用一种以上的 TdP 标签药物。
结果
在研究期间，共登记了 410 例使用 TdP 风险药物标签的 TdP 病例；205 名女性和 205 名男性，平均年龄分别为 74.0 岁和 71.5 岁。抗抑郁药占主导地位（129/410，30%），其次是抗心律失常药（17%）。与低钾血症或低镁血症诱导相关的利尿剂和胃酸分泌抑制剂分别在 410 例 TdP 病例中使用了 56%和 32%。在最常用的抗抑郁药中，西酞普兰具有已知的 TdP1 风险，与米氮平（可能的 TdP2）和舍曲林（有条件的 TdP3）相比，每 10 万使用者的绝对数量和 TdP 发生率都更高（高两倍至四倍）。经常观察到多种危险因素，包括年龄较大、心血管疾病和使用一种以上的 TdP 分类药物。
结论
在有 TdP 诊断的成年人中，抗抑郁药和抗心律失常药是 TdP 风险药物的主要用药，其中大多数人年龄≥65 岁。在为老年患者开抗抑郁药时，应考虑 TdP 风险类别和同时使用的药物。
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