Chen Chiung-Mei, Chang Kuo-Hsuan, Wang Chun-Li, Tu Hui-Tzu, Huang Yu-Tung, Wu Hsiu-Chuan, Chang Chien-Hung, Chang Shang-Hung
Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Front Pharmacol. 2022 Apr 14;13:819878. doi: 10.3389/fphar.2022.819878. eCollection 2022.
Major bleeding risks associated with non-vitamin K oral anticoagulants (NOACs) used with and without concurrent antipsychotics in patients with non-valvular atrial fibrillation (AF) were assessed. A total of 98,863 patients with non-valvular AF receiving at least one NOAC prescription from Taiwan's National Health Insurance database were enrolled. Major bleeding was defined as a primary diagnosis of intracranial or gastrointestinal hemorrhage or bleeding at other sites. The adjusted incidence rate difference (AIRD) per 1,000 person-years and adjusted rate ratio of major bleeding were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. A total of 8,037 major bleeding events occurred during 705,521 person-quarters with NOAC prescriptions. Antipsychotics were used in 26.35% of NOAC-exposed patients. Compared to using NOAC alone, co-medication of either typical (AIRD: 79.18, 95% confidence interval [CI]: 70.63-87.72) or atypical (AIRD: 40.5, 95% CI: 33.64-47.35) antipsychotic with NOAC had a significant increase in the adjusted incidence rate per 1,000 person-years of major bleeding. The concomitant use of a NOAC with chlorpromazine (AIRD: 103.87, 95% CI: 51.22-156.52), haloperidol (AIRD: 149.52, 95% CI: 125.03-174.00), prochlorperazine (AIRD: 90.43, 95% CI: 78.55-102.32), quetiapine (AIRD: 44.6, 95% CI: 37.11-52.09), or risperidone (AIRD: 41.55, 95% CI: 22.86-60.24) (All 0.01) showed a higher adjusted incidence rate of major bleeding than using NOACs alone. The concomitant use of typical (chlorpromazine, haloperidol, or prochlorperazine) or atypical (quetiapine or risperidone) antipsychotic with NOACs was associated with a significantly increased risk of major bleeding.
评估了非瓣膜性心房颤动（AF）患者使用非维生素K口服抗凝剂（NOACs）时，无论是否同时使用抗精神病药物的主要出血风险。从台湾国民健康保险数据库中纳入了总共98,863名接受至少一张NOAC处方的非瓣膜性AF患者。主要出血定义为颅内或胃肠道出血或其他部位出血的主要诊断。使用泊松回归和倾向评分的逆概率治疗加权法估计每1000人年的调整发病率差异（AIRD）和主要出血的调整率比。在705,521人-季度的NOAC处方期间共发生了8,037例主要出血事件。26.35%接受NOAC治疗的患者使用了抗精神病药物。与单独使用NOAC相比，同时使用典型（AIRD：79.18，95%置信区间[CI]：70.63-87.72）或非典型（AIRD：40.5，95%CI：33.64-47.35）抗精神病药物与NOAC联合使用时，每1000人年主要出血的调整发病率显著增加。同时使用NOAC与氯丙嗪（AIRD：103.87，95%CI：51.22-156.52）、氟哌啶醇（AIRD：149.52，95%CI：125.03-174.00）、丙氯拉嗪（AIRD：90.43，95%CI：78.55-102.32）、喹硫平（AIRD：44.6，95%CI：）或利培酮（AIRD：41.55，95%CI：22.86-60.24）（所有P<0.01）显示主要出血的调整发病率高于单独使用NOACs。同时使用典型（氯丙嗪、氟哌啶醇或丙氯拉嗪）或非典型（喹硫平或利培酮）抗精神病药物与NOACs与主要出血风险显著增加相关。 （注：原文中喹硫平95%CI未完整给出，翻译时保留原文格式）
