リヴァスキュラライゼーション後のハイパーポリファーマシーまたはそれなしの慢性四肢を脅かす性缺血患者における臨床結果
Taira Kobayashi1, Kazuki Mukai2, Yuichiro Katayama2
1Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi-shi, Hiroshima 738-8503, Japan.
Annals of vascular surgery
|September 5, 2025
まとめ
10種類以上の処方薬を使用すると定義される多用薬は,慢性四肢の危険性のある不血症 (CLTI) の患者でより悪い結果と関連しています. この研究では,多重薬剤治療の患者は,リヴァスキュラライゼーション後に生存率と手足の回復率を著しく低下させました.
科学分野:
- 血管 外科
- 高齢者医療
- 臨床薬理学
背景:
- 高齢者における多剤薬剤使用は,有害な結果と関連して,懸念が高まっている.
- 末端を脅かす慢性性イシュケミア (CLTI) の患者は,多くの薬剤を必要とする複数の併発性疾患を持っています.
- リヴァスキュラライゼーションを受けているCLTI患者に対するハイパーポリファーマシーの影響はよく定義されていません.
研究 の 目的:
- リヴァスキュラライゼーション後のCLTI患者におけるハイパーポリファーマシーと臨床結果の関連性を調査する.
- この患者集団における生存に影響を与える危険因子を特定する.
- ハイパーポリファーマシーを受けた患者と,受けなかった患者のアウトカムを比較する.
主な方法:
- 2014年から2022年の間にCLTIの再血管化を施した患者の後続的評価
- ハイパーポリファーマシーなし (NHP,<10薬) とハイパーポリファーマシー (HP,≥10薬) のグループに分類する.
- カプラン- メイヤーおよび多変量分析を用いた全生存率,心血管死亡率,および手足の回復率の分析.
主要な成果:
- ハイパーポリファーマシー (HP) グループは417人の患者の53%を占め,中位は10薬でした.
- HP患者は,NHPグループと比較して,1年,3年,5年の全生存率が有意に低下した (P < 0. 001).
- 心血管疾患による死亡 (P < 0. 001) と手足の回復 (P = 0. 010) もHP群で減少した. 超多用薬は死亡の独立した予測因子であった (HR, 1. 60).
結論:
- CLTI患者の再血管化後の全生存率に負の関連がある.
- 心血管疾患による死亡と肢体回復の減少は,このコホートにおける多重薬剤の重要な結果である.
- 臨床管理戦略では,CLTI患者の薬剤負担を考慮して結果を改善する必要があります.
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