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ディルティアゼムとアピキサバンまたはリバロキサバンを使用している患者における重度の出血
Wayne A Ray1, Cecilia P Chung2,3, C Michael Stein4,5
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA
|April 15, 2024
まとめ
アピキサバンまたはリバロキサバンの治療を受けている心房細動患者におけるディルティアゼムの使用は,メトプロロールと比較して重度の出血のリスクが高い. このリスクは,ディルチアゼムの高用量投与で特に顕著です.
科学分野:
- 心臓病科
- 薬理学について
- 臨床研究
背景:
- アトリアルフィブリレーション (AF) の治療には,しばしばアピキサバンやリバロキサバンなどの抗凝固薬が用いられます.
- カルシウムチャネル阻害剤であるディルチアゼムは,AF患者の心房回転率の制御に頻繁に使用されます.
- ディルティアゼムは,特定の抗凝固剤の代謝を阻害し,出血のリスクを増やす可能性があります.
研究 の 目的:
- アピキサバンまたはリバロキサバンとAFの新規使用者の重度の出血のリスクを比較する.
- これらの患者におけるディルチアゼムまたはメトプロロールの使用と出血の関連性を評価する.
主な方法:
- アピキサバンまたはリバロキサブンを開始したAFのメディケア受給者 (≥65歳) の遡及コホート研究.
- ディルティアゼムとメトプロロールを併用した患者の出血リスクの比較
- 最長365日間の追跡調査で,重複加減を用いて調整された危険比率 (HRs) と速度差 (RDs) を用いた.
主要な成果:
- ディルチアゼムの使用はメトプロロールと比較して,主要な複合結果 (出血入院/死亡) のリスクの増加と関連していました (RD: 10. 6/ 1000 PY; HR: 1.21).
- より高いディルチアゼム用量 (> 120 mg/ d) は,主要なアウトカム (RD: 15. 1/1000 PY; HR: 1.29) と重度の不血症または出血事件 (HR: 1.14) のリスクがより高いことが示されました.
- グループ間では,不全性脳卒中/全身性血栓のリスクの有意な差異は認められなかった.
結論:
- アピキサバンやリバロキサバンで治療中のAF患者では,ディルティアゼムはメトプロロールよりも重度の出血のリスクが高い.
- ディルチアゼムの出血リスクの増加は用量に依存し,特に120 mg/ dを超える用量では顕著です.
- これらの発見は,新しい経口抗凝固剤とディルチアゼムを処方する際の薬物相互作用と患者特有のリスクの重要性を強調しています.
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