在透析患者接受皮肤穿透冠状动脉干预时,药物的使用是禁忌的
Thomas T Tsai1, Thomas M Maddox, Matthew T Roe
1Denver VA Medical Center, Cardiology Section 111B, 1055 Clermont St, Denver, CO 80220, USA. thomas.tsai@va.gov
JAMA
|December 10, 2009
概括
超过22%的透析患者接受穿皮冠状动脉干预 (PCI) 接受了禁忌的抗血栓药物,导致在医院出血和死亡的风险增加.
科学领域:
- 心血管医学 心血管医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 美国FDA为特定患者群体提供了关于禁用或不建议使用药物的指导方针.
- 关于这些药物在实践中的临床使用和结果的数据有限.
研究的目的:
- 检查透析患者接受皮肤冠状动脉干预 (PCI) 时使用埃诺沙巴林和埃普蒂菲巴提德的利用情况.
- 评估这些禁用药物的使用与患者结局之间的关联.
主要方法:
- 分析了来自美国829家医院的22,778名透析患者的数据,这些患者在2004年至2008年期间接受了PCI.
- 评估医院内出血和死亡作为主要结局.
- 利用多变量调整和倾向得分匹配进行可靠的分析.
主要成果:
- 22.3%的患者接受了禁忌的抗血栓剂,其中埃诺沙巴林和埃皮菲巴提德是常见的.
- 接受这些药物的患者在住院出血 (5.6%对2.9%) 和死亡 (6.5%对3.9%) 的比率更高.
- 调整后的分析证实出血 (OR, 1.66) 和死亡 (OR, 1.24) 的风险增加;倾向性匹配将它们与出血联系起来 (OR, 1.63).
结论:
- 在接受PCI的透析患者中,很大一部分接受了禁忌的抗血栓药物.
- 在倾向匹配分析中,使用这些药物与住院大出血的风险明显增加有关.
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