Univ. Bordeaux, INSERM, BPH, team Pharmacoepidemiology, U1219, Bordeaux, France
Univ. Bordeaux, INSERM, BPH, team Pharmacoepidemiology, U1219, Bordeaux, France.
BMJ. 2022 Mar 23;376:e066192. doi: 10.1136/bmj-2021-066192.
To estimate the risk of ischaemic stroke associated with antidopaminergic antiemetic (ADA) use.
Case-time-control study.
Data from the nationwide French reimbursement healthcare system database Système National des Données de Santé (SNDS).
Eligible participants were ≥18 years with a first ischaemic stroke between 2012 and 2016 and at least one reimbursement for any ADA in the 70 days before stroke. Frequencies of ADA reimbursements were compared for a risk period (days -14 to -1 before stroke) and three matched reference periods (days -70 to -57, -56 to -43, and -42 to -29) for each patient. Time trend of ADA use was controlled by using a control group of 21 859 randomly selected people free of the event who were individually matched to patients with stroke according to age, sex, and risk factors of ischaemic stroke.
Association between ADA use and risk of ischaemic stroke was assessed by estimating the ratio of the odds ratios of exposure evaluated in patients with stroke and in controls. Analyses were adjusted for time varying confounders (anticoagulants, antiplatelets, and prothrombotic or vasoconstrictive drugs).
Among the 2612 patients identified with incident stroke, 1250 received an ADA in the risk period and 1060 in the reference periods. The comparison with the 5128 and 13 165 controls who received an ADA in the same periods yielded a ratio of adjusted odds ratios of 3.12 (95% confidence interval 2.85 to 3.42). Analyses stratified by age, sex, and history of dementia showed similar results. Ratio of adjusted odds ratios for analyses stratified by ADA was 2.51 (2.18 to 2.88) for domperidone, 3.62 (3.11 to 4.23) for metopimazine, and 3.53 (2.62 to 4.76) for metoclopramide. Sensitivity analyses suggested the risk would be higher in the first days of use.
Using French nationwide exhaustive reimbursement data, this self-controlled study reported an increased risk of ischaemic stroke with recent ADA use. The highest increase was found for metopimazine and metoclopramide.
评估使用抗多巴胺类止吐药（ADA）与缺血性卒中风险之间的关系。
病例时间对照研究。
利用法国全国性的医疗报销健康系统数据库 Système National des Données de Santé（SNDS）的数据进行研究。
纳入标准为年龄≥18 岁，在 2012 年至 2016 年期间首次发生缺血性卒中，且在卒中前 70 天内至少有一次 ADA 报销记录。为每位患者设置一个风险期（卒中前-14 天至-1 天）和三个匹配的参考期（-70 天至-57 天、-56 天至-43 天和-42 天至-29 天），比较 ADA 报销频率。通过使用一个对照组来控制 ADA 使用的时间趋势，该对照组由 21859 名随机选择的、未发生该事件的人组成，他们根据年龄、性别和缺血性卒中的危险因素与卒中患者进行个体匹配。
通过评估在卒中患者和对照组中暴露的比值比来评估 ADA 使用与缺血性卒中风险之间的关系。分析结果经过了时变混杂因素（抗凝剂、抗血小板药物、促血栓形成或血管收缩药物）的调整。
在 2612 例确诊的卒中患者中，1250 例在风险期内接受了 ADA 治疗，1060 例在参考期内接受了 ADA 治疗。与在同一时期内接受 ADA 治疗的 5128 名和 13165 名对照者进行比较，调整后的比值比为 3.12（95%置信区间 2.85 至 3.42）。按年龄、性别和痴呆史分层的分析结果类似。按 ADA 分层的调整比值比为：多潘立酮 2.51（2.18 至 2.88）、甲哌氯丙嗪 3.62（3.11 至 4.23）和甲氧氯普胺 3.53（2.62 至 4.76）。敏感性分析提示，ADA 近期使用与缺血性卒中风险增加有关，且风险在使用的最初几天最高。
本病例自身对照研究利用法国全国性的详尽报销数据，报道了 ADA 近期使用与缺血性卒中风险增加之间存在相关性。甲氧氯普胺和甲哌氯丙嗪的风险增加最为显著。
Zotero 插件
