Worsham Rebecca, Wood Robert, Radford Andrea Jill
James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee.
Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City.
Fed Pract. 2024 Dec;41(12):1-7. doi: 10.12788/fp.0540. Epub 2024 Dec 23.
Posthoc analyses have found an increased bleeding risk in oral anticoagulation with concomitant nonsteroidal anti-inflammatory drug (NSAID) use. However, this research was primarily conducted in mixed populations prescribed both direct oral anticoagulants (DOACs) and warfarin. Research evaluating bleeding risk with NSAID use among DOACs alone is limited. This study evaluates bleeding rates in patients taking rivaroxaban and apixaban with and without NSAID use and investigates the potential impact of NSAID selectivity or proton pump inhibitor (PPI) coprescribing.
This single-center retrospective cohort study compared bleeding rates between rivaroxaban or apixaban among NSAID and non-NSAID users. The primary endpoint was a composite of any bleeding event per International Society on Thrombosis and Haemostatis criteria. The secondary endpoint was bleeding rates for NSAID users based on NSAID choice and PPI coprescribing.
The study included 681 patients on rivaroxaban and 3225 patients on apixaban. Seventy-two patients on rivaroxaban (10.6%) and 300 patients on apixaban (9.3%) were NSAID users. There was no statistically significant difference between rivaroxaban and apixaban among NSAID users (hazard ratio 1.04; 95% CI, 0.98-1.12) or non-NSAID users (hazard ratio 1.15; 95% CI, 0.80-1.66). There was no clinically significant difference observed for NSAID selectivity or PPI coprescribing for NSAID users.
Bleeding rates were not significantly different between patients taking rivaroxaban and patients taking apixaban, regardless of NSAID use. A population health management tool may provide a safe approach for coprescribing NSAIDs with DOACs. Additional prospective studies are needed to quantify the comparative bleeding risk with concomitant NSAID use among DOACs alone.
事后分析发现，口服抗凝药与非甾体抗炎药（NSAID）联合使用时出血风险增加。然而，这项研究主要是在同时使用直接口服抗凝剂（DOAC）和华法林的混合人群中进行的。单独评估DOAC使用者使用NSAID时出血风险的研究有限。本研究评估了使用和未使用NSAID的利伐沙班和阿哌沙班患者的出血率，并调查了NSAID选择性或质子泵抑制剂（PPI）联合使用的潜在影响。
这项单中心回顾性队列研究比较了NSAID使用者和非NSAID使用者中利伐沙班或阿哌沙班的出血率。主要终点是根据国际血栓与止血学会标准定义的任何出血事件的复合终点。次要终点是根据NSAID选择和PPI联合使用情况，NSAID使用者的出血率。
该研究纳入了681名利伐沙班使用者和3225名阿哌沙班使用者。72名利伐沙班使用者（10.6%）和300名阿哌沙班使用者（9.3%）为NSAID使用者。NSAID使用者中，利伐沙班和阿哌沙班之间无统计学显著差异（风险比1.04；95%置信区间，0.98-1.12）；非NSAID使用者中，两者也无统计学显著差异（风险比1.15；95%置信区间，0.80-1.66）。对于NSAID使用者，NSAID选择性或PPI联合使用情况未观察到临床显著差异。
无论是否使用NSAID，服用利伐沙班的患者和服用阿哌沙班的患者出血率无显著差异。人群健康管理工具可能为DOAC与NSAID联合使用提供一种安全的方法。需要更多前瞻性研究来量化单独使用DOAC时联合使用NSAID的相对出血风险。
