控制速率的药物和直接口服抗凝剂之间的潜在相互作用:基于人群的队列和病例交叉研究
Angel Y S Wong1, Charlotte Warren-Gash1, Krishnan Bhaskaran1
1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Heart rhythm
|June 23, 2024
概括
与阿米奥达龙或diltiazem同时使用的直接口服抗凝剂 (DOAC) 没有增加出血或心血管风险. 然而,开始使用阿米奥达龙或迪尔提亚的DOAC与更高的死亡风险有关.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 心血管医学 心血管医学
- 药物安全与药物相互作用
背景情况:
- 直接口服抗凝剂 (DOAC) 经常与阿米奥达龙,迪尔提亚泽姆和维拉帕米尔一起被处方.
- 对于DOACs和这些特定的心血管药物之间的药物相互作用的潜力仍然不清楚.
研究的目的:
- 评估与同时使用DOACs和阿米奥达龙,迪尔提亚泽姆或维拉帕米尔相关的临床风险.
- 为了比较这些风险与DOACs与β-阻断剂的使用.
主要方法:
- 使用临床实践研究数据链接Aurum (2011-2019) 采用了一个队列研究设计.
- 估计了主要临床结果的危险比率,比较了DOACs + amiodarone/diltiazem/verapamil用户与DOACs +β-阻断剂用户.
- 此外,还使用了案例交叉设计来评估围绕结果事件的暴露模式.
主要成果:
- 在队列分析中,DOACs + amiodarone/diltiazem/verapamil使用者和DOACs + β-阻断剂使用者之间没有发现出血或心血管事件的风险增加.
- 病例交叉分析显示,在使用阿米奥达龙时启动DOAC时,所有原因死亡率的几率比率较高 (2.09).
- 同样增加的死亡风险被观察到与diltiazem开始与DOACs一起.
结论:
- 与阿米奥达龙,迪尔提亚泽姆或维拉帕米尔同时处方的DOAC似乎不会增加出血或心血管风险.
- 心血管和全因死亡的风险增加与DOAC治疗的启动阶段特别相关,当与阿米奥达龙或diltiazem联合使用时.
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