非维生素 K 拮抗剂：与其他药物相互作用时出血的风险：来自 Medicare 的队列研究。
Nonvitamin K Anticoagulants: Risk of Bleeding When Interacting With Other Medications: A Cohort Study From Medicare.
机构信息
Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA.
Department of Health Outcomes, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.
出版信息
Clin Cardiol. 2024 Oct;47(10):e70023. doi: 10.1002/clc.70023.
INTRODUCTION
Patients on nonvitamin K antagonist (NVKA) are usually taking other drugs. Potential interaction may increase the gastrointestinal (GI) bleeding risk associated with NVKA.
METHODS
Observational cohort study using Medicare data from 2017 to 2020. Participants receiving a NVKA were included. A concomitant overlapping period while on NVKA was assessed for nonsteroidal anti-inflammatory drugs (NSAIDS), selective serotonin reuptake inhibitors (SSRI), antiplatelets, glucocorticoids, aspirin and proton pump inhibitors (PPI). A logistic regression predicting either any bleeding or GI bleeding was conducted estimating the odds ratio (OR) and 95% confidence interval (CI).
RESULTS
A total of 102 531 people on NVKA with mean age 77 years (SD = 9.8) and 55% females (N = 56 671) were included. Previous history of GI bleeding occurred in 2 908 (2.8%) participants, concomitant exposure to PPI occurred in 38 713 (38%), SSRI in 16 487 (16%), clopidogrel in 15 795 (15.4%), NSAIDs in 13 715 (13.4%) and glucocorticoids in 13 715 (13.4%). Risk for any bleeding was shown for clopidogrel (OR: 1.37, 95% CI: 1.30, 1.44), prasugrel/ticagrelor (OR: 1.36, 95% CI: 1.18, 1.58), glucocorticoids (OR: 1.26, 95% CI: 1.19, 1.34), and SSRIs (OR: 1.13, 95% CI: 1.07, 1.19). GI bleeding risk was shown for clopidogrel (OR: 1.44, 95% CI: 1.34, 1.55), prasugrel/ticagrelor (OR: 1.47, 95% CI: 1.20, 1.79), SSRIs (OR: 1.09, 95% CI: 1.01, 1.17) and glucocorticoids (OR: 1.33, 95% CI: 1.23, 1.44). PPI use was correlated with both NSAID (r = 0.07, p ≤ 0.0001) and SSRI use (r = 0.09, p ≤ 0.0001).
CONCLUSION
NVKA concomitantly taken with antiplatelets, glucocorticoids, and SSRIs showed an increased risk for any bleeding and GI bleeding.
介绍
服用非维生素 K 拮抗剂（NVKA）的患者通常还在服用其他药物。潜在的相互作用可能会增加与 NVKA 相关的胃肠道（GI）出血风险。
方法
使用 2017 年至 2020 年的医疗保险数据进行观察性队列研究。纳入正在服用 NVKA 的患者。评估 NVKA 同时重叠期间使用非甾体抗炎药（NSAIDs）、选择性 5-羟色胺再摄取抑制剂（SSRI）、抗血小板药物、皮质类固醇、阿司匹林和质子泵抑制剂（PPI）的情况。使用 logistic 回归预测任何出血或 GI 出血，估计比值比（OR）和 95%置信区间（CI）。
结果
共纳入 102531 名服用 NVKA 的患者，平均年龄为 77 岁（标准差=9.8），55%为女性（N=56671）。2808 名（2.8%）参与者有既往 GI 出血史，38713 名（38%）参与者同时暴露于 PPI，16487 名（16%）参与者同时暴露于 SSRI，15795 名（15.4%）参与者同时暴露于氯吡格雷，13715 名（13.4%）参与者同时暴露于 NSAIDs，13715 名（13.4%）参与者同时暴露于皮质类固醇。氯吡格雷（OR：1.37，95%CI：1.30，1.44）、普拉格雷/替格瑞洛（OR：1.36，95%CI：1.18，1.58）、皮质类固醇（OR：1.26，95%CI：1.19，1.34）和 SSRIs（OR：1.13，95%CI：1.07，1.19）与任何出血风险增加相关。氯吡格雷（OR：1.44，95%CI：1.34，1.55）、普拉格雷/替格瑞洛（OR：1.47，95%CI：1.20，1.79）、SSRI（OR：1.09，95%CI：1.01，1.17）和皮质类固醇（OR：1.33，95%CI：1.23，1.44）与 GI 出血风险增加相关。PPI 使用与 NSAIDs（r=0.07，p≤0.0001）和 SSRIs（r=0.09，p≤0.0001）均相关。
结论
NVKA 同时服用抗血小板药物、皮质类固醇和 SSRIs 会增加任何出血和 GI 出血的风险。
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