直接口服抗凝剂和非类固醇抗炎药物之间的药物相互作用:临床风险效益分析,重点关注特殊人群
Antonella Mameli1, Francesco Marongiu, Doris Barcellona
1Hemostasis and Thrombosis Unit, AOU Cagliari, Italy.
American journal of therapeutics
|February 20, 2026
概括
直接口服抗凝剂 (DOAC) 和非类固醇抗炎药物 (NSAID) 在一起使用时会增加出血风险. 建议在最低有效剂量和最短持续时间的NSAIDs的明智使用在DOACs的患者.
科学领域:
- 药理学和临床医学 药理学和临床医学
- 药物相互作用和患者安全
背景情况:
- 直接口服抗凝剂 (DOAC) 对于控制心房动和静脉血栓塞栓症至关重要.
- 非类固醇抗炎药物 (NSAIDs) 经常被用于治疗DOAC患者的疼痛和炎症.
- 联合使用DOACs和NSAIDs会增加出血的风险,这是由于添加剂的药理动力学和潜在的药理动力学相互作用.
研究的目的:
- 审查与DOAC和NSAID联合使用相关的出血风险的证据.
- 为特定患者群体和药物类别确定当前指导方针中关于分层建议的空白.
- 探索影响DOAC和NSAID代谢的药理学相互作用的临床相关性.
主要方法:
- 从2005年1月到2024年12月,在主要数据库 (PubMed/MEDLINE,Scopus,Web of Science) 中进行了结构化的文献搜索.
- 搜索术语包括"直接口服抗凝剂"",NSAIDs"",出血"",药物相互作用"和相关的MeSH标题.
- 包括的研究类型包括药理学研究,临床试验,现实世界分析,审查和元分析,严格选和资格评估.
主要成果:
- 同时使用NSAIDs和DOACs通过对血小板和胃肠道粘膜的协同作用显著增加出血风险.
- 目前的指导方针缺乏详细的分层建议,用于高风险患者群体或特定的NSAID/DOAC药物的这种组合管理.
- 药物动力学相互作用 (例如,涉及CYP3A4,P-gp) 对联合DOAC-NSAID治疗的临床影响需要进一步的现实研究.
结论:
- 虽然已认识到出血风险,但对接受DOAC治疗的患者完全禁止使用NSAID并不合理.
- 在选择的临床场景中,建议谨慎使用NSAIDs,在最短的必要时间内使用最低有效剂量.
- 需要进一步的研究来完善基于证据的策略,以减轻这种患者群体的出血风险.
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