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血管事件后长期抗血小板治疗的年龄特定风险,严重程度,时间进程和结果:基于人口的队列研究
Linxin Li1, Olivia C Geraghty1, Ziyah Mehta1
1Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Lancet (London, England)
|June 18, 2017
概括
接受抗血小板治疗的老年人面临严重胃肠道出血的更高风险. 常规使用质子抑制剂 (PPI) 为预防严重出血.
科学领域:
- 心血管医学
- 胃肠病学
- 老年医学
背景情况:
- 在缺血性血管事件后,终身抗血小板治疗是标准的,主要研究年轻患者 (< 75 岁).
- 胃肠上部出血是已知的并发症,但对抗血小板药物的长期影响和风险不太清楚.
- 同时处方的质子抑制剂 (PPI) 显著降低了肠道出血,但吸收率很低,指导方针各不相同.
研究的目的:
- 在接受抗血小板治疗的各个年龄段患者中评估出血的风险,时间和结果.
- 评估常规的PPI联合处方在预防上部肠道出血方面对年龄特定的益处.
主要方法:
- 在接受抗血小板药物的第一次过渡性缺血性发作,缺血性中风或心肌梗塞的患者中进行的前性基于人群的队列研究 (牛津血管研究,2002 - 2013年).
- 面对面的10年随访以确定出血类型,严重程度,结果 (残疾/死亡) 和时间.
- 基于Kaplan- Meier估计和先前的试验数据,计算需要治疗的年龄特定数量 (NNT).
主要成果:
- 随着年龄的增长,严重出血的风险显著增加 (HR为≥75岁),尤其是致命出血 (HR为5. 53).
- 在老年人中,主要的上部消化道出血特别高 (HR 4. 13在75岁以上),残疾或死亡的风险很大 (HR 10. 26).
- 在75岁以上的患者中,致残/ 致命的上肠道出血 (9. 15/1000个患者年) 超过致残/ 致命的脑内出血.
- 在5年内,预防一次致残/致死上肠道出血的NNT从338 (年龄<65) 降至25 (年龄≥85).
结论:
- 在老年患者中,服用抗血小板药物的长期严重出血风险比之前显示的更高,更持久.
- 在接受抗血小板治疗的老年患者中,致残性或致命的上部肠道出血构成重大威胁.
- 对于服用抗血小板药物的老年人来说,由于NNT较低,常规的PPI联合处方强烈建议,以预防严重的胃肠道出血.
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