Adverse Events Associated with Antipsychotic Use in Hospitalized Older Adults After Cardiac Surgery.
Adverse Events Associated with Antipsychotic Use in Hospitalized Older Adults After Cardiac Surgery.
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DOI：
10.1111/jgs.14768
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发表时间：
2017-06
影响因子：
6.3
通讯作者：
Bateman BT
中科院分区：
文献类型：
--
作者：
Kim DH;Huybrechts KF;Patorno E;Marcantonio ER;Park Y;Levin R;Abdurrob A;Bateman BT
评价心脏手术后与典型和非典型抗精神病药物相关的院内不良事件。回顾队列研究美国全国住院患者数据库，2003-2014年间，3,706名患者(平均年龄70岁)在冠状动脉旁路移植或瓣膜手术后新接受口服非典型抗精神病药物治疗(N=2,580)与口服典型抗精神病药物治疗(N=1,126)。在倾向得分匹配的队列中，住院死亡率、心律失常、肺炎、使用脑成像(替代过度镇静和神经系统事件)以及服药后住院时间，非典型药物的中位治疗时间为3天(四分位数范围[IQR]，1~6天)，典型药物的中位治疗时间为2天(IQR，1~3天)。住院死亡率无显著差异(非典型与典型药物：5.4%与5.3%；风险差异[RD]，0.1%；95%可信区间[CI]，−2.1至2.3)，心律失常(2.0%vs 2.2%；RD，0.0%；95%CI，−1.4至1.4)，肺炎(16.1%vs.14.5%；RD，1.6%；住院天数(9.9天比9.3天；平均差0.5天；95%可信区间，−1.2~2.2)。然而，与典型药物相比，在开始使用非典型药物后，使用脑成像更普遍(17.3%对12.4%；RD，4.9%；95%CI，1.4至8.4)。在接受心脏手术的住院患者中，与非典型药物相比，短期使用典型抗精神病药物与不良事件的风险相似。此外，与非典型药物相关的脑成像的增加表明，这些药物可能会导致过度镇静或不良神经事件。然而，由于事件发生率相对较低，我们的分析不能排除非典型药物和典型药物之间不良事件的轻微差异。
To evaluate in-hospital adverse events associated with typical and atypical antipsychotic drugs after cardiac surgery. Retrospective cohort study United States nationwide inpatient database, 2003–2014 3,706 patients (mean age, 70 years) newly treated with oral atypical antipsychotic drugs (N=2,580) vs. oral typical antipsychotic drugs (N=1,126) after coronary artery bypass grafting or valve surgery. In-hospital mortality, arrhythmia, pneumonia, use of brain imaging (surrogate for over-sedation and neurologic events), and length of stay after drug initiation In the propensity-score matched cohort, the median treatment duration was 3 days (interquartile range [IQR], 1 to 6 days) for atypical drugs and 2 days (IQR, 1 to 3 days) for typical drugs. There were no large differences in in-hospital mortality (atypical vs. typical drugs: 5.4% vs. 5.3%; risk difference [RD], 0.1%; 95% confidence interval [CI], −2.1 to 2.3), arrhythmia (2.0% vs. 2.2%; RD, 0.0%; 95% CI, −1.4 to 1.4), pneumonia (16.1% vs. 14.5%; RD, 1.6%; 95% CI, −1.9 to 5.0), and length of stay (9.9 days vs. 9.3 days; mean difference, 0.5 days; 95% CI, −1.2 to 2.2). Use of brain imaging, however, was more common after initiating atypical drugs relative to typical drugs (17.3% vs. 12.4%; RD, 4.9%; 95% CI, 1.4 to 8.4). In hospitalized patients who underwent cardiac surgery, short-term use of typical antipsychotic drugs was associated with similar risks of adverse events compared with atypical drugs. Moreover, increased use of brain imaging associated with atypical drugs suggests that these drugs may cause over-sedation or adverse neurologic events. Due to the relatively low event rates, however, our analysis could not exclude modest differences in adverse events between atypical and typical drugs.