経皮冠動脈干渉を受ける透析患者における薬剤の使用は禁忌です
Thomas T Tsai1, Thomas M Maddox, Matthew T Roe
1Denver VA Medical Center, Cardiology Section 111B, 1055 Clermont St, Denver, CO 80220, USA. thomas.tsai@va.gov
JAMA
|December 10, 2009
まとめ
経皮冠動脈干渉 (PCI) を受けている透析患者の22%以上は,抗血栓薬の投与が禁忌であり,入院中の出血や死亡のリスクが増加しました.
科学分野:
- 心血管医学 心血管医学
- ネフロロジーは腎臓科
- 薬理学 薬理学とは
背景:
- 米国FDAは,特定の患者グループに対して,禁忌または推奨されない薬物使用に関するガイドラインを提供しています.
- これらの薬の臨床的使用と実践における結果に関するデータは限られている.
研究 の 目的:
- 経皮冠動脈干渉 (PCI) を受けている透析患者におけるエノキサパリンとエプティフィバチドの利用を調査する.
- これらの禁忌薬の使用と患者のアウトカムとの関連性を評価する.
主な方法:
- 2004年から2008年の間にPCIを受けた829の米国病院の22,778人の透析患者のデータを分析した.
- 主なアウトカムとして,入院中の出血と死亡の評価.
- 多変数調整と傾向スコアマッチングを活用し,信頼性の高い分析を行いました.
主要な成果:
- 患者の22.3%が抗指向の抗血栓剤を投与され,エノキサパリンとエプティフィバチドが一般的であった.
- これらの薬剤を投与された患者は,入院出血 (5.6%対2.9%) と死亡率 (6.5%対3.9%) が高かった.
- 調整した分析により,出血 (OR,1.66) と死亡 (OR,1.24) のリスクの増加が確認された.
結論:
- PCIを受けた透析患者の有意な割合は,抗血栓性薬の投与が禁忌であった.
- これらの薬の使用は,傾向マッチ分析では,入院中の大出血のリスクが著しく高かった.
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