Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul, Korea.
Sci Rep. 2023 Feb 4;13(1):2060. doi: 10.1038/s41598-023-29185-9.
Anti-tuberculosis treatment can cause significant drug-drug interaction and interfere with effective anticoagulation. However, there is a lack of evidence and conflicting data on the optimal oral anticoagulation in patients treated for tuberculosis. We investigated the safety and effectiveness of anticoagulation with non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in patients on anti-tuberculosis treatment. Patients on concomitant oral anticoagulation and anti-tuberculosis treatment including rifampin were identified from the Korean nationwide healthcare database. Subjects were censored at discontinuation of either anticoagulation or rifampin. The outcomes of interest were major bleeding, death, and ischemic stroke. A total 2090 patients (1153 on warfarin, 937 on NOAC) were included. NOAC users, compared to warfarin users, were older, had a lower prevalence of hypertension, heart failure, ischemic stroke, and aspirin use and a higher prevalence of cancer, with no significant differences in CHADS-VASc or HAS-BLED scores. There were 18 major bleeding events, 106 deaths, and 50 stroke events during a mean follow-up of 2.9 months. After multivariable adjustment, the use of NOAC was associated with a lower risk of incident ischemic stroke (HR 0.51, 95% CI 0.27-0.94), while there was no significant difference in risk for major bleeding or death compared with warfarin. These results suggest that NOACs have better effectiveness for stroke prevention and similar safety compared with warfarin in patients on concomitant anti-tuberculosis treatment. This is the first study assessing the safety and effectiveness of NOACs compared to warfarin in this clinical scenario.
抗结核治疗可能会引起显著的药物相互作用，并干扰有效的抗凝治疗。然而，对于正在接受结核病治疗的患者，最佳的口服抗凝治疗方案缺乏证据且存在数据冲突。我们研究了在接受抗结核治疗的同时使用非维生素 K 拮抗剂口服抗凝剂（NOAC）和华法林抗凝的安全性和有效性。从韩国全国医疗保健数据库中确定了同时接受口服抗凝和抗结核治疗（包括利福平）的患者。研究对象在停止抗凝或利福平治疗时被剔除。主要研究终点为大出血、死亡和缺血性卒中。共纳入 2090 例患者（华法林组 1153 例，NOAC 组 937 例）。与华法林组相比，NOAC 组患者年龄较大，高血压、心力衰竭、缺血性卒中和阿司匹林使用率较低，癌症患病率较高，CHADS-VASc 或 HAS-BLED 评分无显著差异。平均随访 2.9 个月期间，共发生 18 例大出血事件、106 例死亡和 50 例卒中事件。多变量调整后，与华法林相比，使用 NOAC 与较低的缺血性卒中发生率（HR 0.51，95%CI 0.27-0.94）相关，而大出血或死亡的风险与华法林相比无显著差异。这些结果表明，在同时接受抗结核治疗的患者中，NOAC 与华法林相比，在预防卒中方面具有更好的效果，且安全性相当。这是第一项在该临床情况下评估 NOAC 与华法林安全性和有效性的研究。
