达比加群与金黄色葡萄球菌菌血症风险：一项全国性队列研究。

Dabigatran and the Risk of Staphylococcus aureus Bacteremia: A Nationwide Cohort Study.

机构信息

Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.

出版信息

Clin Infect Dis. 2021 Aug 2;73(3):480-486. doi: 10.1093/cid/ciaa661.

DOI:10.1093/cid/ciaa661

PMID:32478836

Abstract

BACKGROUND

Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of S. aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor dabigatran compared with patients treated with the factor Xa-inhibitors rivaroxaban, apixaban, and edoxaban.

METHODS

In this observational cohort study, 112 537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes in exposure status during follow-up.

RESULTS

A total of 112 537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95% confidence interval [CI], 19.7-26.3] and 33.8 [95% CI, 30.5-37.6] events per 10 000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio, .76; 95% CI, .63-.93).

CONCLUSIONS

Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.

摘要

背景

口服直接凝血酶抑制剂达比加群治疗可降低体外和体内模型中金黄色葡萄球菌的毒力。然而，达比加群是否降低人类金黄色葡萄球菌感染的风险仍有待确定。我们研究了与接受利伐沙班、阿哌沙班和依度沙班等 Xa 因子抑制剂治疗的患者相比，接受直接凝血酶抑制剂达比加群治疗的心房颤动患者金黄色葡萄球菌菌血症（SAB）的发生率。

方法

在这项观察性队列研究中，我们从丹麦全国登记处确定了 112537 名于 2011 年 8 月至 2017 年 12 月期间开始接受直接口服抗凝剂治疗的心房颤动患者。通过多变量 Cox 回归，考虑到随访期间暴露状态的时变变化，检查了达比加群治疗组与 Xa 因子抑制剂治疗组患者的 SAB 发生率。

结果

共纳入 112537 名患者。在中位随访 2.0 年期间，达比加群组有 186 名患者和 Xa 因子抑制剂组有 356 名患者因 SAB 入院。与 Xa 因子抑制剂组相比，达比加群组 SAB 的粗发生率较低（22.8[95%置信区间，19.7-26.3]和 33.8[95%置信区间，30.5-37.6]每 10000 人年事件）。在调整分析中，与 Xa 因子抑制剂相比，达比加群与 SAB 的发生率显著降低相关（发生率比，0.76；95%置信区间，0.63-0.93）。