Petersen Søren Riis, Bonnesen Kasper, Grove Erik Lerkevang, Pedersen Lars, Schmidt Morten
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
Eur Heart J. 2025 Jan 3;46(1):58-68. doi: 10.1093/eurheartj/ehae736.
The bleeding risk of using non-steroidal anti-inflammatory drugs (NSAIDs) in patients treated with oral anticoagulants for venous thromboembolism (VTE) remains unclear.
A nationwide cohort study of 51 794 VTE patients initiating oral anticoagulants between 1 January 2012 and 31 December 2022 was conducted. Time-dependent multivariate cause-specific Cox regression was used to compute adjusted hazard ratios between NSAID use and hospital-diagnosed bleeding episodes.
Event rates for any bleeding per 100 person-years were 3.5 [95% confidence interval (CI), 3.4-3.7] during periods without NSAID use and 6.3 (95% CI, 5.1-7.9) during periods with NSAID use (number needed to harm = 36 patients treated for 1 year). Compared with non-use, the adjusted hazard ratios for any bleeding associated with NSAID use were 2.09 (95% CI, 1.67-2.62) overall, 1.79 (95% CI, 1.36-2.36) for ibuprofen, 3.30 (95% CI, 1.82-5.97) for diclofenac, and 4.10 (95% CI, 2.13-7.91) for naproxen. Compared with non-use, the adjusted hazard ratios associated with NSAID use were 2.24 (95% CI, 1.61-3.11) for gastrointestinal bleeding, 3.22 (95% CI, 1.69-6.14) for intracranial bleeding, 1.36 (95% CI, .67-2.77) for thoracic and respiratory tract bleeding, 1.57 (95% CI, .98-2.51) for urinary tract bleeding, and 2.99 (95% CI, 1.45-6.18) for anaemia caused by bleeding. Results were consistent for anticoagulant and VTE subtypes.
Patients treated with oral anticoagulants for VTE had a more than two-fold increased bleeding rate when using NSAIDs. This increased bleeding rate was not restricted to the gastrointestinal tract.
在接受口服抗凝药治疗静脉血栓栓塞症（VTE）的患者中，使用非甾体抗炎药（NSAIDs）的出血风险尚不清楚。
对2012年1月1日至2022年12月31日期间开始使用口服抗凝药的51794例VTE患者进行了一项全国性队列研究。采用时间依赖性多变量特定病因Cox回归计算NSAIDs使用与医院诊断的出血事件之间的调整后风险比。
在未使用NSAIDs期间，每100人年的任何出血事件发生率为3.5[95%置信区间（CI），3.4 - 3.7]，在使用NSAIDs期间为6.3（95%CI，5.1 - 7.9）（伤害所需人数 = 36例接受1年治疗的患者）。与未使用相比，NSAIDs使用相关的任何出血的调整后风险比总体为2.09（95%CI，1.67 - 2.62），布洛芬为1.79（95%CI，1.36 - 2.36），双氯芬酸为3.30（95%CI，1.82 - 5.97），萘普生为4.10（95%CI，2.13 - 7.91）。与未使用相比，NSAIDs使用相关的调整后风险比，胃肠道出血为2.24（95%CI，1.61 - 3.11），颅内出血为3.22（95%CI，1.69 - 6.14），胸及呼吸道出血为1.36（95%CI，0.67 - 2.77），泌尿道出血为1.57（95%CI，0.98 - 2.51），出血引起的贫血为2.99（95%CI，1.45 - 6.18）。抗凝剂和VTE亚型的结果一致。
接受口服抗凝药治疗VTE的患者在使用NSAIDs时出血率增加了两倍多。这种增加的出血率并不局限于胃肠道。
