Relation of Nonsteroidal Anti-inflammatory Drugs to Serious Bleeding and Thromboembolism Risk in Patients With Atrial Fibrillation Receiving Antithrombotic Therapy A Nationwide Cohort Study
Relation of Nonsteroidal Anti-inflammatory Drugs to Serious Bleeding and Thromboembolism Risk in Patients With Atrial Fibrillation Receiving Antithrombotic Therapy A Nationwide Cohort Study
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DOI：
10.7326/m13-1581
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发表时间：
2014-11-18
影响因子：
39.2
通讯作者：
Gislason, Gunnar H.
中科院分区：
文献类型：
--
作者：
Lamberts, Morten;Lip, Gregory Y. H.;Gislason, Gunnar H.
背景资料：非甾体类抗炎药（NSAID）被认为会增加出血风险，但其与正在接受抗血栓药物治疗的房颤（AF）患者严重出血的实际关系尚不清楚。目的：研究与持续NSAID和抗血栓治疗相关的严重出血和血栓栓塞风险。设计：观察性队列研究。设置：全国登记。患者：1997年至2011年期间住院的丹麦AF患者。测量：使用考克斯模型评估持续NSAID和抗血栓治疗的严重出血和血栓栓塞的绝对风险。（中位年龄75岁[四分位距65 - 83岁]; 47%为女性），53732例（35.6%）在中位随访6.2年（四分位距2.1 - 14.0年）期间接受了NSAID处方。分别有17187例（11.4%）和19561例（13.0%）发生严重出血和血栓栓塞。在3个月时，NSAID暴露14天内严重出血的绝对风险为3.5起事件/1000例患者，而非NSAID暴露的患者为1.5起事件/1000例患者。风险差异为1.9起事件/1000例患者。在选择口服抗凝剂治疗的患者中，绝对风险差异为每1000例患者2.5起事件。在所有抗血栓治疗方案和NSAID类型中，使用NSAID与严重出血和血栓栓塞的绝对风险增加相关。NSAID剂量高于推荐的最低剂量与出血风险比大幅增加有关。局限性：观察设计和未测量的混杂因素。结论：使用NSAID与AF患者严重出血和血栓栓塞的独立风险相关。短期NSAID暴露与出血风险增加相关。医生应在AF患者中谨慎使用NSAID。
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown.Objective: To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy.Design: Observational cohort study.Setting: Nationwide registries.Patients: Danish patients with AF hospitalized between 1997 and 2011.Measurements: Absolute risk for serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy, assessed by using Cox models.Results: Of 150 900 patients with AF (median age, 75 years [interquartile range, 65 to 83 years]; 47% female), 53 732 (35.6%) were prescribed an NSAID during a median follow-up of 6.2 years (interquartile range, 2.1 to 14.0 years). There were 17 187 (11.4%) and 19 561 (13.0%) occurrences of serious bleeding and thromboembolism, respectively. At 3 months, the absolute risk for serious bleeding within 14 days of NSAID exposure was 3.5 events per 1000 patients compared with 1.5 events per 1000 patients without NSAID exposure. The risk difference was 1.9 events per 1000 patients. In patients selected for oral anticoagulant therapy, the absolute risk difference was 2.5 events per 1000 patients. Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding.Limitation: Observational design and unmeasured confounders.Conclusion: Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with AF. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with AF.