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非ビタミンK抗体とビタミンK抗体による経口抗凝固剤を服用した患者の脳内出血と病院での死亡率との関連
Taku Inohara1, Ying Xian1,2, Li Liang1
1Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
JAMA
|January 27, 2018
まとめ
肝臓内出血 (ICH) の前には,非ビタミンK抗体 (NOAC) やワルファリンを投与していた患者は,入院死亡率が高かった. NOACの使用は,ウォルファリンと比較して死亡リスクの低下と関連していました.
科学分野:
- 神経学
- 心臓病科
- 薬理学について
背景:
- 非ビタミンK 反抗性経口抗凝固剤 (NOAC) は,血栓塞栓性疾患の予防のためにますます処方されています.
- NOACを使用する患者の脳内出血 (ICH) のアウトカムに関するデータは限られている.
研究 の 目的:
- ICH以前の経口抗凝固剤 (OAC) 使用 (ウォルファリン,NOAC,またはOACなし) と入院死亡率との関連を評価する.
- ICH患者におけるNOACとワルファリンの死亡リスクを比較する.
主な方法:
- ICHを患った141,311人の患者による遡及コホート研究.
- 入院前7日間の抗凝固治療の分析
- OACグループにおける入院死亡率の比較
主要な成果:
- ICH前にワルファリン (10. 6%) またはNOACs (3. 5%) を服用した患者は,OACsを受けていない患者と比較して,入院死亡率が高かった.
- NOACの使用は,OACを使用しないと比較して,入院死亡率 (AOR,1.21) の低いリスクと関連していました.
- ウォルファリンの使用は,OACsに比べて,病院での死亡率 (AOR,1. 62) の有意に高いリスクに関連していた.
- ウォルファリンと比較して,NOACの使用は入院死亡リスクの低下と関連していました (AOR,0. 75).
結論:
- ICH患者におけるワルファリンまたはNOACの使用は,入院死亡率の増加と関連しています.
- NOACは,ICHの文脈でワーファリンと比較して,病院での死亡リスクが低いことを示しています.
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