同时使用非甾体抗炎药和口服抗凝剂会使老年人面临患出血性消化性溃疡疾病的高风险。

Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease.

作者信息

Shorr R I, Ray W A, Daugherty J R, Griffin M R

机构信息

Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.

出版信息

Arch Intern Med. 1993 Jul 26;153(14):1665-70.

PMID:8333804

Abstract

BACKGROUND

Although joint use of nonsteroidal anti-inflammatory drugs (NSAIDs) and oral anticoagulants may increase the risk of gastrointestinal tract hemorrhage in elderly persons, no epidemiologic studies have been performed to quantify this risk.

METHODS

We performed a retrospective cohort study of Tennessee Medicaid enrollees aged 65 years or older from 1984 through 1986. A total of 103,954 individuals contributed 209,066 person-years of follow-up, including 2203 person-years of current oral anticoagulant use, to the study.

RESULTS

Of the cohort members, 1371 had confirmed hospitalizations for peptic ulcer disease. Of these, 661 (48%) presented with frank hematemesis or melena and thus met the definition for hemorrhagic peptic ulcer disease. Among current users of oral anticoagulants, the adjusted incidence of hospitalization for peptic ulcer disease was 14.3 per 1000 person-years, and the adjusted incidence of hospitalization for hemorrhagic peptic ulcer disease was 10.2 per 1000 person-years. Compared with nonusers, current anticoagulant users were at increased risk for hospitalization for ulcer disease (relative risk, 2.2; 95% confidence interval, 1.6 to 3.1), primarily due to the increased risk of hospitalization for hemorrhagic ulcers (relative risk, 3.3; 95% confidence interval, 2.3 to 4.9). Compared with nonusers of either drug, the relative risk of hemorrhagic peptic ulcer disease among current users of both anticoagulants and NSAIDs was 12.7 (95% confidence interval, 6.3 to 25.7). However, the prevalence of NSAID use among anticoagulant users was 13.5%, the same as in those who were not using anticoagulants.

CONCLUSIONS

The nearly 13-fold increase in the risk of developing hemorrhagic peptic ulcer disease in concurrent users of oral anticoagulants and NSAIDs suggests that NSAIDs should be prescribed with extreme caution in patients undergoing anticoagulation therapy.

摘要

背景

尽管非甾体抗炎药（NSAIDs）与口服抗凝剂联合使用可能会增加老年人胃肠道出血的风险，但尚无流行病学研究对该风险进行量化。

方法

我们对1984年至1986年田纳西州医疗补助计划中65岁及以上的参保者进行了一项回顾性队列研究。共有103,954人参与研究，随访时间达209,066人年，其中包括2203人年的当前口服抗凝剂使用情况。

结果

在队列成员中，1371人因消化性溃疡病确诊住院。其中，661人（48%）出现明显的呕血或黑便，因此符合出血性消化性溃疡病的定义。在当前口服抗凝剂使用者中，消化性溃疡病住院的校正发病率为每1000人年14.3例，出血性消化性溃疡病住院的校正发病率为每1000人年10.2例。与未使用者相比，当前抗凝剂使用者患溃疡病住院的风险增加（相对风险，2.2；95%置信区间，1.6至3.1），主要是由于出血性溃疡住院风险增加（相对风险，3.3；95%置信区间，2.3至4.9）。与两种药物都不使用者相比，当前同时使用抗凝剂和NSAIDs的使用者发生出血性消化性溃疡病的相对风险为12.7（95%置信区间，6.3至25.7）。然而，抗凝剂使用者中NSAIDs的使用率为13.5%，与未使用抗凝剂者相同。