抗凝剂相关的胃肠道出血的危险因素:系统性审查和元分析
Fuxin Ma1, Shuyi Wu1, Shiqi Li1
1Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
The Korean journal of internal medicine
|December 8, 2023
概括
新的研究确定了服用抗凝药的患者中胃肠道出血的关键风险因素. 贫血和心力衰竭是新发现的预测因素之一,改善了与抗凝剂相关的胃肠道出血的风险评估.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 胃肠病学 胃肠病学
- 临床风险预测预测
背景情况:
- 抗凝固疗法至关重要,但存在胃肠道出血 (GIB) 的风险.
- 现有的抗凝剂相关的GIB风险预测模型可能不包括所有显著因素.
- 对于这些风险因素,以前缺乏系统审查和证据确定性评估.
研究的目的:
- 进行系统审查,以确定与抗凝剂相关的GIB的所有风险因素.
- 评估已识别的风险因素的证据的确定性.
- 为抗凝剂相关的GIB提供风险预测模型和临床管理策略的信息.
主要方法:
- 进行了全面的系统审查和元分析.
- 搜索了主要数据库 (PubMed,EMBASE,科学网,科克兰图书馆) 从创立到2022年1月21日.
- 包括34项研究,分析抗凝固剂相关GIB的风险因素.
主要成果:
- 中等确定性证据将老年,病,心力衰竭,心肌梗塞,贫血和特定药物相互作用 (例如阿司匹林,抗血小板药物,gemfibrozil) 与GIB联系起来.
- 确定的因素如贫血,INR,心力衰竭和心肌梗塞并未始终包括在当前的GIB风险预测模型中.
- 其他相关因素包括H. pylori感染,酒精使用,吸烟和社会风险因素.
结论:
- 贫血,特定的药物相互作用 (gemfibrozil,verapamil,diltiazem),INR,心力衰竭和心肌梗塞是抗凝相关GIB的显著预测因素.
- 这些已识别的因素并未完全纳入现有的风险预测模型.
- 结果将加强GIB风险预测,为预防准则提供信息,并指导未来对抗凝血管理的研究.
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