抗血栓薬の使用と体下血腫のリスクとの関連
David Gaist1, Luis Alberto García Rodríguez2, Maja Hellfritzsch3
1Department of Neurology, Odense University Hospital, Odense, Denmark2Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense.
JAMA
|March 1, 2017
まとめ
抗血栓薬,特にビタミンKアンタゴニスト (VKA) と抗血小板薬の併用は,下皮血腫のリスクを大幅に増加させる. 抗血栓薬の使用の増加は,特に高齢者の体内血腫の発生率の増加と相関しています.
科学分野:
- 神経学
- 薬理学について
- 流行病学
背景:
- 副皮質血腫の発生率は上昇しており,抗血栓薬の使用との関連は不明です.
- 抗血栓薬は,特に高齢者向けに,ますます処方されています.
研究 の 目的:
- 抗血栓薬の使用と体内血腫 (SDH) のリスクとの関連を調査する.
- 一般集団におけるSDH発生率と抗血栓薬の使用傾向を分析する.
主な方法:
- デンマークの10,010人のSDH患者と400,380人の対照群を対象とした集団ベースの症例対照研究 (2000年−2015年).
- SDHの発生率と抗血栓薬の使用 (低用量アスピリン,クロピドグレル,直接経口抗凝固薬,ビタミンK抗剤) に関する地域および国のデータの分析.
- 条件付きロジスティック回帰モデルは,調整されたオッズ比率 (ORs) を推定するために使用されました.
主要な成果:
- 抗血栓薬の使用は,より高いSDHリスクと関連しており,調整されたORは,低用量アスピリンでは1. 24からVKAでは3. 69であった.
- 併用VKAと抗血小板治療は,最も高いリスクを示した (調整されたORは7. 93まで).
- SDHの発生率は10万人当たり10. 9から19. 0に増加した (2000年−2015年),これは抗血栓薬の使用量の増加を反映した (1000人当たり31. 0から76. 9).
結論:
- 抗血栓薬の使用は,下皮質血腫のリスクの増加と関連しています.
- ビタミンKアンタゴニストと抗血小板薬の併用は最もリスクが高い.
- 高齢者における抗血栓薬,特にVKAの使用量の増加は,おそらく,下皮質血腫の発生率の上昇を促している.
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