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Oluwadolapo D Lawal1, Herbert D Aronow2,3, Fisayomi Shobayo4

  • 1Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA.

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PubMed
まとめ

心房細動 (AF) と胃腸出血 (GIB) の歴のある患者では,治癒後の直接経口抗凝固剤 (DOACs) の再投与は,ワルファリンと比較して出血と複合的な有害事象のリスクが低いことが示されました.

キーワード:
心房細動直接服用する抗凝固剤大きな出血ウォルファリン

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科学分野:

  • 心臓病科
  • 胃腸内科
  • 薬理学について

背景:

  • 主要な胃腸出血 (GIB) の後の心房細動 (AF) の患者で,ウォルファリンと対比して直接の経口抗凝固薬 (DOACs) の再開に関するデータは限られている.
  • AF患者における重大な出血の後に抗凝固剤の治療を最適化するには,ガイドが必要です.

研究 の 目的:

  • 主要なGIBで入院したAF患者におけるDOACとワルファリンの再開のリスク・利益プロフィールを比較する.
  • 高リスク患者集団における様々な抗凝固剤の安全性と有効性を評価する.

主な方法:

  • 商業医療保険のデータベース (2010年−2017年) を遡って分析した結果,重度のGIBで入院したAF患者さんを特定した.
  • 退院後90日以内に生存し,経口抗凝固薬 (DOACsまたはワルファリン) を再開した患者も含まれていた.
  • コバリアートとアウトカムを比較するために,安定化逆確率の治療重み (IPTW) が使用された.

主要な成果:

  • 抗凝固薬を再開した4, 389人の患者のうち,DOACsは31. 3%,ワルファリンは68. 7%でした.
  • 重度の出血による入院リスクが24%減少した (HR: 0. 76, 95% CI: 0. 60- 0. 96).
  • DOACは,純有害性臨床効果 (NACE) の複合結果のリスクも低かった (HR: 0. 83,95%CI: 0. 72- 0. 97).

結論:

  • 主要な胃腸出血 (GIB) の後のAF患者における直接口服抗凝固剤 (DOACs) の再投与は,その後の主要な出血のリスクの減少と関連しています.
  • DOACsは,このコホートにおける主要な出血および複合的な有害事象に対するワルファリンと比較して有利なリスクプロファイルを示した.
  • これらの発見は,重度のGIBを経験したAF患者の抗凝固管理のためのDOACを考慮することを支持する.