Bleeding complications in patients on celecoxib and warfarin
Bleeding complications in patients on celecoxib and warfarin
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DOI：
10.1111/j.1365-2710.2005.00676.x
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发表时间：
2005-10-01
影响因子：
2
通讯作者：
Bush, TM
中科院分区：
文献类型：
--
作者：
Chung, L;Chakravarty, EF;Bush, TM
目的：与单独使用华法林相比，非选择性非甾体抗炎药（nNSAIDs）与华法林联合使用会导致上消化道出血（UGIB）的风险增加约3倍。塞来昔布是环氧化酶2（考克斯-2）的选择性抑制剂，与nNSAID相比，其胃粘膜损伤和血小板失调较少。我们比较了服用塞来昔布和华法林的患者出血并发症的发生率与那些服用华法林单独。主题和方法：我们进行了回顾性分析，从我们的Protime诊所和药房数据库从2001年1月至2004年4月的数据。我们确定了123例同时服用塞来昔布和华法林的患者（重叠组）。我们比较了该组与1022例单独服用华法林的对照组患者的出血并发症发生率。出血并发症被定义为严重的，如果他们导致住院，输血或death.Results：在大约1063个月的接触塞来昔布和华法林，10出血并发症，其中只有一个被认为是重大的。无患者发生UGIB。在对照组中，在暴露于华法林的约16520个月内确定了116例出血并发症，其中101例轻微事件和15例重大事件，包括6例UGIB发作。所有出血并发症的相对危险度为1.34（95%CI：0.70-2.57），在重叠与对照组，和大出血为1.04（95%CI：0.14-7.85）。结论：有一个轻微的，但不显着增加出血并发症的患者服用塞来昔布和华法林相比，那些单独服用华法林。
Purpose: Non-selective non-steroidal anti-inflammatory drugs (nNSAIDs) used in combination with warfarin are associated with an approximately 3-fold increased risk of upper gastrointestinal bleeding (UGIB) compared with warfarin alone. Celecoxib, a selective inhibitor of cyclo-oxygenase 2 (COX-2), is associated with less gastric mucosal injury and platelet dysregulation than nNSAIDs. We compared rates of bleeding complications in patients taking celecoxib and warfarin with those taking warfarin alone.Subjects and Methods: We performed a retrospective analysis using data from our Protime Clinic and pharmacy databases from January 2001 to April 2004. We identified 123 patients who took celecoxib and warfarin concurrently (overlap group). We compared rates of bleeding complications in this group with 1022 control patients who were taking warfarin alone. Bleeding complications were defined as major if they resulted in hospitalization, blood transfusion or death.Results: During approximately 1063 months of exposure to both celecoxib and warfarin, 10 bleeding complications were identified, only one of which was considered major. No patients had UGIB. In the control group, 116 bleeding complications were identified over approximately 16 520 months of exposure to warfarin alone, with 101 minor and 15 major events, including six episodes of UGIB. The relative risk of all bleeding complications was 1.34 (95% CI: 0.70-2.57) in the overlap vs. control groups, and for major bleeds was 1.04 (95% CI: 0.14-7.85).Conclusions: There is a mild but non-significant increase in bleeding complications in patients taking celecoxib and warfarin compared with those taking warfarin alone.