停药与继续使用他类药物:一个系统性审查
Cayden Peixoto1, Yasmeen Choudhri2, Sara Francoeur1
1Institut du Savoir Montfort, Ottawa, Ontario, Canada.
Journal of the American Geriatrics Society
|July 25, 2024
概括
停止使用他类药物可能不会影响临终期患者的短期死亡率. 然而,对于其他人群来说,停止他类药物可能会增加死亡率和心血管事件的风险,尽管证据不确定.
科学领域:
- 心血管医学 心血管医学
- 临床药理学 临床药理学
背景情况:
- 临床医生和患者经常讨论继续或停止他类药物治疗.
- 评估停用或继续使用他类药物的临床影响对于患者护理至关重要.
研究的目的:
- 评估与继续治疗相比,停止使用他类药物的对关键临床结果的影响.
- 检查的结果包括全因死亡率,心血管死亡率,心血管事件和生活质量.
主要方法:
- 进行了系统性审查,包括随机对照试验 (RCT),队列研究,病例控制研究和准随机研究.
- 在MEDLINE,Embase和Cochrane中央注册表中进行了搜索,直到2023年8月. 数据提取和质量评估由独立审查员进行.
- 使用叙事综合和元分析,使用GRADE来评估证据的确定性. 对于75岁及以上的个体,也总结了研究结果.
主要成果:
- 有36项研究 (37份报告) 符合条件,包括1项RCT和35项非随机研究,涉及超过170万参与者.
- 在预期寿命小于1年的患者中,单一的RCT在停止使用他类药物后的60天死亡率上没有显著差异.
- 非随机化研究一致表明,停用他类药物可能与全因死亡率 (HR 1.92),心血管死亡率 (HR 1.63) 和心血管事件 (HR 1.31) 的风险增加有关,由于方法限制,不确定性很高.
结论:
- 根据有限的RCT数据,中止他类药物可能不会影响临终期患者的短期死亡率.
- 对于其他患者群体,观察性研究表明,他类药物停用与不良结果之间存在潜在的关联,但由于不确定性,这需要进一步调查.
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