アトリアルフィブリレーションと制御不能の甲状腺機能低下症の患者におけるアピキサバン使用の臨床結果の評価: 現実世界の証拠
Khalid Al Sulaiman1,2,3,4,5, Manal A Aljohani1,2,3, Abdullah F Alharthi6
1Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
まとめ
アピキサバンのような経口抗凝固剤は,控えめな甲状腺機能低下症を有する心房細動患者において,血栓形成および大出血のリスクを増加させる可能性があります. この患者グループについてはさらなる研究が必要である.
科学分野:
- 心臓病科
- 内分泌学
- 薬理学について
背景:
- 心房細動 (AF) は 世界的な健康問題であり,脳卒中のリスクを高めています.
- アピキサバンなどの直接経口抗凝固薬 (DOACs) は,AFの管理に好ましい.
- 甲状腺機能障害がDOACの有効性と安全性に与える影響は十分に理解されていません.
研究 の 目的:
- 制御されていない甲状腺機能低下症のAF患者におけるアピキサバンの有効性と安全性を評価する.
- アピキサバン投与中の非制御性甲状腺機能低下症の患者と非制御性甲状腺機能低下症の患者の間での血栓と出血を比較する.
主な方法:
- アピキサバンを投与開始した292人のAF患者の遡及コホート分析.
- 制御されていない甲状腺機能低下症 (n=51) と対照群 (n=241) に分類された患者.
- 2次結果: 血流,脳卒中,静脈血栓塞栓 (VTE)
主要な成果:
- 制御されていない甲状腺機能低下群では,血栓形成の発生率が高かった (17. 6% vs 8. 4%).
- 甲状腺機能低下群では脳卒中 (4. 26) と大出血 (6. 21) の調整された確率比 (aOR) が著しく高かった.
- 群の間でVTEや小出血の有意な差は認められませんでした.
結論:
- 控えめな甲状腺機能低下症の患者におけるアピキサバンの使用は,血栓形成と重度の出血のリスクの増加と関連しています.
- 結果は,この集団における注意深いモニタリングと潜在的な投与量調整の検討を示唆しています.
- これらの発見を確認するために,より大きな前向きな研究が必要である.
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