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评估diltiazem或维拉帕米尔与直接口服抗凝剂的同时使用:元分析

Kazuhiko Kido¹, Mikiko Shimizu², Tsuyoshi Shiga³

¹Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.

The Annals of pharmacotherapy

|May 6, 2025

概括

将直接口服抗凝剂 (DOAC) 与迪尔提亚或维拉帕米尔结合使用显著增加出血风险. 这种疗法也降低了中风风险,但整体出血问题对患者安全至关重要.

科学领域:

药理学和心脏病学药理学和心脏病学
药物相互作用药物相互作用
临床风险评估临床风险评估

背景情况:

迪尔提亚和维拉帕米尔是中度CYP3A4和P-葡萄糖蛋白抑制剂.
这些药物可以显著增加直接口服抗凝剂 (DOAC) 度.
同时使用可能会增加出血风险,之前的研究显示了相互矛盾的结果.

研究的目的:

为了评估与联合迪尔提亚泽姆/维拉帕米尔和DOAC治疗相比DOAC单独治疗相关的出血和中风风险.
综合现实研究的证据,以澄清这种药物组合的安全性.

主要方法:

一项对研究进行的元分析,比较了同时使用diltiazem/verapamil和DOAC治疗与DOAC单一治疗.
在MEDLINE和谷歌学者中进行的搜索截至2024年11月16日.
主要结局:严重出血;次要结局:中风/全身血栓塞,胃肠道出血.

主要成果:

分析包括6项研究.
同时治疗显著增加大出血 (OR=1.38) 和胃肠道出血 (OR=1.19) 的风险.
观察到,中风或全身血栓塞的风险明显降低 (OR=0.83).

结论:

同时使用DOAC与diltiazem/verapamil,与DOAC单独治疗相比,会增加出血风险.
虽然中风风险可能会降低,但增加的出血风险需要在临床实践中仔细考虑.

关键词:

艾皮克萨班 (Apixaban) 是一种流血流血流血流血达比加特兰 (达比加特兰)他们用 diltiazem 进行调节.药物相互作用药物相互作用埃多克萨班 (EDOXABAN) 是一种这是一个元分析.里瓦洛克萨班 (Rivaroxaban) 是一个一次性中风中风中风中风中风维拉帕米尔 (verapamil) 是一种非常有效的药物.

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