Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults
Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults
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DOI：
10.1016/j.amjmed.2011.08.014
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发表时间：
2012-02-01
影响因子：
5.9
通讯作者：
Kuo, Yong-Fang
中科院分区：
文献类型：
--
作者：
Baillargeon, Jacques;Holmes, Holly M.;Kuo, Yong-Fang
背景：抗生素药物与接受华法林的患者出血风险增加有关。最近来自医疗保险D部分处方药项目的数据提供了一个机会来评估抗生素药物与接受华法林的全国老年人出血风险之间的关系。方法：我们对38,762例65岁及以上持续使用华法林的患者进行了一项病例对照研究，使用了5%的全国医疗保险受益人D部分福利样本的登记和索赔数据。病例定义为因初步诊断为出血而住院的患者，并根据年龄、种族、性别和华法林适应症与3名对照受试者相匹配。使用Logistic回归分析计算与既往抗生素药物暴露相关的出血风险的调整优势比（aORs）和95%置信区间（CIs）。结果：事件/指标日期后15天内暴露于任何抗生素均与出血风险增加相关（aOR 2.01; 95% CI, 1.62-2.50）。所有6种特异性抗生素药物（唑类抗真菌药[aOR， 4.57; 95% CI, 1.90-11.03]、大环内酯类[aOR， 1.86; 95% CI, 1.08-3.21]、喹诺酮类[aOR， 1.69; 95% CI, 1.09-2.62]、复方新诺明[aOR， 2.70; 95% CI, 1.46-5.05]、青霉素类[aOR， 1.92; 95% CI, 1.21-2.07]和头孢菌素[aOR， 2.45; 95% CI, 1.52-3.95]）均与出血风险增加相关。结论：在持续使用华法林的老年人中，暴露于抗生素药物，特别是唑类抗真菌药物，与出血风险增加有关。(C) 2012爱思唯尔公司版权所有。美国医学杂志（2012）125,183-189
BACKGROUND: Antibiotic medications are associated with an increased risk of bleeding among patients receiving warfarin. The recent availability of data from the Medicare Part D prescription drug program provides an opportunity to assess the association of antibiotic medications and the risk of bleeding in a national population of older adults receiving warfarin.METHODS: We conducted a case-control study nested within a cohort of 38,762 patients aged 65 years and older who were continuous warfarin users, using enrollment and claims data for a 5% national sample of Medicare beneficiaries with Part D benefits. Cases were defined as patients hospitalized for a primary diagnosis of bleeding and were matched with 3 control subjects on age, race, sex, and indication for warfarin. Logistic regression analysis was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the risk of bleeding associated with prior exposure to antibiotic medications.RESULTS: Exposure to any antibiotic agent within the 15 days of the event/index date was associated with an increased risk of bleeding (aOR 2.01; 95% CI, 1.62-2.50). All 6 specific antibiotic drug classes examined (azole antifungals [aOR, 4.57; 95% CI, 1.90-11.03], macrolides [aOR, 1.86; 95% CI, 1.08-3.21], quinolones [aOR, 1.69; 95% CI, 1.09-2.62], cotrimoxazole [aOR, 2.70; 95% CI, 1.46-5.05], penicillins [aOR, 1.92; 95% CI, 1.21-2.07], and cephalosporins [aOR, 2.45; 95% CI, 1.52-3.95]) were associated with an increased risk of bleeding.CONCLUSION: Among older continuous warfarin users, exposure to antibiotic agents-particularly azole antifungals-was associated with an increased risk of bleeding. (C) 2012 Elsevier Inc. All rights reserved. The American Journal of Medicine (2012) 125, 183-189