在同时使用口服抗凝剂和皮质类固醇爆发时,较大出血的比较风险
Tsung-Chieh Yao1,2, Sheng-Mao Chang3, Yi-Fen Tsai4
1Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Clinical and translational science
|July 27, 2025
概括
与华法林相比,非维生素K口服抗凝剂 (NOAC) 在心房患者中与口服皮质类固醇 (OCS) 爆发一起使用时,显示出较低的重大出血风险. 埃多克萨班的发病率最低,而华法林的发病率最高.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 在心房的患者中,同时使用口服抗凝剂和口服皮质类固醇 (OCS) 爆发是常见的.
- 与这种联合疗法相关的大型出血风险的特征不清楚,特别是比较不同类型的口服抗凝剂.
研究的目的:
- 为了比较非维生素K口服抗凝剂 (NOACs) 与华法林在重大出血风险方面的安全性.
- 为了特别评估接受OCS爆发治疗心房动的患者的这种风险.
主要方法:
- 一项基于全国人口的队列研究利用了国家健康保险研究数据库.
- 研究了NOACs (edoxaban, apixaban, dabigatran, rivaroxaban) 或华法林与OCS爆发治疗期间严重出血之间的关联.
- 根据基线差异进行调整,使用重叠权重来估计发病率,发病率风险比率 (IRR) 和调整后的危险比率 (AHR).
主要成果:
- 在接受OCS爆发的50,390名患者中,NOAC与与华法林 (AHR = 0.57) 相比,严重出血的风险明显较低.
- 华法林与OCS爆发疗法一起表现出最大的重大出血发病率 (67.30/1000人年).
- 对NOAC的发病率较低:埃多克萨班 (30.36),阿皮克萨班 (34.93),达比加特兰 (42.47) 和里瓦罗克萨班 (46.99) 每1000人/年.
结论:
- 在心房患者中,NOAC与与OCS爆发联合使用时,与华法林相比,与较低的重大出血风险有关.
- 埃多克萨班在研究的NOAC中显示出最大出血的发病率最低.
- 这些发现突显出各种口服抗凝剂和OCS爆发疗法组合之间出血风险的显著差异.
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