年齢特有のリスク,重症度,時間経過,および血管疾患後の長期抗血小板治療による出血の結果:集団ベースのコホート研究

Linxin Li¹, Olivia C Geraghty¹, Ziyah Mehta¹

¹Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.

Lancet (London, England)

|June 18, 2017

まとめ

抗血小板治療を受けている高齢者は,重度の胃腸出血のリスクが高い. この集団では,重度の出血を防ぐために,定期的なプロトンポンプ阻害剤 (PPI) の使用が推奨されます.

科学分野:

心血管医学
胃腸内科
高齢者医療

背景:

主に若い患者 (75歳未満) で研究されている.
上部胃腸 (GI) 出血は既知の合併症ですが,抗血小板薬を服用している高齢者の長期的な影響とリスクはあまり理解されていません.
プロトンポンプ阻害剤 (PPI) の併用は,腸内出血を著しく減少させるが,吸収量は低く,ガイドラインは異なる.

研究の目的:

2次予防のために抗血小板治療を受けているすべての年齢の患者の出血のリスク,タイミング,結果の評価.
上部胃腸出血の予防にPPIを併用する年齢特有の効果を評価する.

主な方法:

抗血小板薬を服用した第1回過渡性性血栓性発作,血栓性脳卒中,または心筋梗塞の患者による前向きな集団コホート研究 (オックスフォード血管研究,2002年 - 2013年).
血液の種類,重症度,結果 (障害/死亡),時間経過を決定する10年間の対面フォローアップ.
カプラン- メイヤーの推定値と以前の試験データに基づいて,PPIの治療に必要な年齢別数 (NNT) の計算.

主要な成果:

重度の出血のリスクは年齢とともに顕著に増加した (HR 3. 10は75歳以上),特に致命的な出血 (HR 5. 53).
高齢者における上部腸内出血は特に高かった (HR 4. 13は75歳以上),障害や死亡のリスクはかなり高かった (HR 10. 26).
75歳以上の患者では,障害となる/致死する上部腸内出血 (9. 15/ 1000患者年) が障害となる/致死する脳内出血よりも多い.
5年間で障害となる/致死的な上部消化器官出血を防ぐためのNNTは338歳 (65歳未満) から25歳 (85歳以上) に減少した.

結論:

抗血小板薬を服用する長期の大量出血のリスクは,以前に示されたより高齢の患者で高く,より持続しています.
抗血小板治療を受けている高齢者の場合,障害となるか致命的な上部腸内出血が重大な脅威となる.
抗血小板薬を服用している高齢者に,重度の消化器内出血を防ぐために,定期的なPPIの併用は強く推奨されます.

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