JACC:NOAC增加NVAF患者重度肝损伤风险?

2018-04-08 吴星 环球医学

2018年3月,发表在《J Am Coll Cardiol》的一项由德国和加拿大科学家进行的研究考察了非维生素K拮抗剂口服抗凝药(NOAC)与重度肝损伤风险之间的相关性。

2018年3月,发表在《J Am Coll Cardiol》的一项由德国和加拿大科学家进行的研究考察了非维生素K拮抗剂口服抗凝药(NOAC)与重度肝损伤风险之间的相关性。

背景:NOACs是用于非瓣膜性房颤(NVAF)患者卒中预防的相对较新的药物。然而,其使用可能与肝毒性相关引发了关注。

目的:本研究的目的是确定与维生素K拮抗剂(VKAs)相比,NOACs的使用是否与NVAF合并和不合并既往肝病患者重度肝损伤风险增加相关。

方法:使用加拿大魁北克省健康保险管理数据库,研究者在2011年1月~2014年12月新确诊为NVAF的患者中进行了一项队列研究。使用时间依赖Cox成比例风险模型评估当前使用NOACs vs当前使用VKAs的情况下,合并或不合并既往肝病的NVAF患者中,重度肝损伤(定义为住院或相关死亡)的校正风险比(HRs)和95% 置信区间(CIs)。

结果:队列由51887例患者组成,包括3778例既往肝病患者。68739人-年的随访期中,585例患者出现了重度肝损伤。与当前使用VKAs相比,当前使用NOACs与合并或不合并既往肝病患者的重度肝损伤风险的增加不相关(分别为校正HR:0.99;95% CI,0.68~1.45;校正HR:0.68;95% CI,0.33~1.37)。

结论:与VKAs相比,NOACs与重度肝损伤风险增加不相关,并独立于基线肝状态。总体来说,这些结果提供了NOACs肝脏安全性的保证。

原始出处

Douros A, et al. Non-Vitamin K Antagonist Oral Anticoagulants and Risk of Serious Liver Injury. J Am Coll Cardiol. 2018 Mar 13;71(10):1105-1113. doi: 10.1016/j.jacc.2018.01.009.

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    2019-02-05 zhmscau
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    2018-11-06 hbwxf
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