JAMA:抗栓药物使用增加带来的意外伤害:硬膜下血肿

2017-04-19 贾朝娟 环球医学

硬膜下血肿的发病率在不断增加,与抗栓药物使用增加是否相关呢?2017年2月,发表在《JAMA》的一项研究显示,在丹麦,抗栓药物使用和较高的硬膜下血肿风险相关;VKA和抗血小板药物联合使用导致硬膜下血肿发生的风险最高。重要性:硬膜下血肿的发病率在不断增加。在何种程度上与抗栓药物使用增加相关仍不清楚。目的:考察抗栓药物使用与硬膜下血肿风险之间的关联,并在普通人群中考察硬膜下血肿发病率和抗栓药物使用的趋

硬膜下血肿的发病率在不断增加,与抗栓药物使用增加是否相关呢?2017年2月,发表在《JAMA》的一项研究显示,在丹麦,抗栓药物使用和较高的硬膜下血肿风险相关;VKA和抗血小板药物联合使用导致硬膜下血肿发生的风险最高。

重要性:硬膜下血肿的发病率在不断增加。在何种程度上与抗栓药物使用增加相关仍不清楚。

目的:考察抗栓药物使用与硬膜下血肿风险之间的关联,并在普通人群中考察硬膜下血肿发病率和抗栓药物使用的趋势。

设计、环境和受试者:这项病例-对照研究纳入2000至2015年期间首发硬膜下血肿的10010名年龄为20~89岁的患者,按根据年龄、性别和日历年与400380名普通人群(对照)进行匹配。采用来自丹麦的基于人群的区域数据(人群:484346)和全国数据(人群:520万)识别硬膜下血肿发病率和抗栓药物的使用情况。采用条件逻辑回归模型估算比值比(ORs),并校正并发症、教育水平和收入水平。

暴露:使用低剂量阿司匹林、氯吡格雷、维生素K拮抗剂(VKA)、直接口服抗凝药,和抗栓药物联合治疗。

主要结局和测试指标:硬膜下血肿与抗栓药物使用、硬膜下血肿发病率和年度抗栓药物治疗使用情况的关联。

结果:在10010名硬膜下血肿的患者(平均年龄,69.2岁;3462名女性[34.6%])中,47.3%进行了抗栓治疗。目前使用低剂量阿司匹林(病例:26.7%,对照:22.4%;校正OR,1.24[95%CI,1.15~1.33])、氯吡格雷(病例:5.0%,对照:2.2%;校正 OR,1.87 [95% CI,1.57~2.24])、直接口服抗凝药(病例:1.0%,对照:0.6%;校正 OR,1.73 [95% CI,1.31~2.28])和VKA(病例:14.3%,对照:4.9%;校正 OR,3.69 [95% CI,3.38~4.03])与较高的硬膜下血肿风险相关。当VKA与抗血小板药物同时使用时,硬膜下血肿的风险最大(低剂量阿司匹林和VKA:病例的3.6%和对照的1.1%;校正OR,4.00[95%CI,3.40~4.79];氯吡格雷和VKA:病例的0.3%和对照的0.04%;校正OR,7.93[95%CI,4.49~14.02])。抗栓药物使用率从2000年每1000名普通人群中有31.0人增加至2015年的每1000人中有76.9人(趋势P<0.001)。总的硬膜下血肿发病率从2000年的10.9/100000患者-年至2015年的19.0/100000患者-年(趋势P<0.001)。老年患者的增加最大(>75岁;n=4441),从55.1/100000患者-年增加至99.7/100000患者-年(趋势P<0.001)。

结论和相关性:在丹麦,抗栓药物的使用和较高的硬膜下血肿风险相关;VKA和抗血小板药物联合使用导致硬膜下血肿发生的风险最高。从2000至2015年期间硬膜下血肿增加的发病率似乎与抗栓药物使用的增加相关,尤其是老年患者使用VKA。

原始出处:

Gaist D, García Rodríguez LA, Hellfritzsch M, Poulsen FR, Halle B, Hallas J3, Pottegard A. Association of Antithrombotic Drug Use With Subdural Hematoma Risk. JAMA. 2017 Feb.

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    2017-04-19 daiyaozu

    学习了,不错

    0

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