Serious Hypoglycemia and Use of Warfarin in Combination With Sulfonylureas or Metformin
Serious Hypoglycemia and Use of Warfarin in Combination With Sulfonylureas or Metformin
复制标题
DOI：
10.1002/cpt.1146
复制
发表时间：
2019-01-01
影响因子：
6.7
通讯作者：
Hennessy, Sean
中科院分区：
文献类型：
--
作者：
Nam, Young Hee;Brensinger, Colleen M.;Hennessy, Sean
先前的研究表明，华法林与某些磺脲类药物同时使用时，可能会增加严重低血糖的风险。然而，其临床意义尚不清楚。我们使用自对照病例系列设计和1999年至2011年的美国医疗补助索赔（补充医疗保险索赔），检查了严重低血糖与华法林与磺脲类或二甲双胍合并使用之间相关性的率比（RR）。在所有合并的风险窗中，华法林与格列美脲（RR，1.47; 95%置信区间（CI），1.07-2.02）和二甲双胍（RR，1.73; 95% CI，1.38-2.16）联合给药时，严重低血糖发生率升高。特别是在后期风险窗口（自开始伴随治疗后>120天），华法林的大多数RR升高：格列吡嗪（RR，1.72; 95% CI，1.29-2.29），格列本脲（RR，1.57; 95% CI，1.15-2.15）、二甲双胍（RR，2.26; 95% CI，1.67-3.05）和格列美脲（RR，1.56; 95% CI，0.97-2.50）。这些结果与先前假设的华法林通过抑制骨钙素羧化对2型糖尿病患者的降血糖作用一致。
Prior research suggests that warfarin, when given concomitantly with some sulfonylureas, may increase the risk of serious hypoglycemia. However, the clinical significance remains unclear. We examined rate ratios (RRs) for the association between serious hypoglycemia and concomitant use of warfarin with either sulfonylureas or metformin using a self-controlled case series design and US Medicaid claims (supplemented with Medicare claims) from 1999 to 2011. Across all risk windows combined, warfarin was associated with an elevated rate of serious hypoglycemia when given concomitantly with glimepiride (RR, 1.47; 95% confidence interval (CI), 1.07-2.02) and metformin (RR, 1.73; 95% CI, 1.38-2.16). Particularly in the late risk window (>120 days since beginning concomitancy), most of the RRs for warfarin were elevated: glipizide (RR, 1.72; 95% CI, 1.29-2.29), glyburide (RR, 1.57; 95% CI, 1.15-2.15), metformin (RR, 2.26; 95% CI, 1.67-3.05), and glimepiride (RR, 1.56; 95% CI, 0.97-2.50). These results are consistent with a previously hypothesized hypoglycemic effect of warfarin in patients with type 2 diabetes through inhibition of the carboxylation of osteocalcin.