Outpatient calcium-channel blockers and the risk of postpartum haemorrhage: a cohort study.
Outpatient calcium-channel blockers and the risk of postpartum haemorrhage: a cohort study.
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门诊钙通道阻滞剂和产后出血的风险：一项队列研究。
DOI：
10.1111/1471-0528.12428
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Fischer,MA
中科院分区：
文献类型：
--
作者：
Bateman,BT;Hernandez-Diaz,S;Huybrechts,KF;Palmsten,K;Mogun,H;Ecker,JL;Seely,EW;Fischer,MA
目的确定门诊患者在分娩时接触钙通道阻滞剂 (CCB) 是否与产后出血 (PPH) 风险增加相关。设计队列研究。背景美国。人口或样本医疗补助受益人。方法我们确定了 9750 名门诊患者的队列，他们服用 CCB、甲基多巴或拉贝洛尔治疗既存高血压或妊娠期高血压，其天数供应与交货重叠； 1226 人接触过 CCB。将接触 CCB 的患者与接触甲基多巴或拉贝洛尔的患者的 PPH 风险进行了比较。使用倾向评分匹配和分层来解决潜在的混杂因素。主要结局指标分娩住院期间发生 PPH。结果有 27 名暴露于 CCB 的患者 (2.2%) 和 232 名暴露于甲基多巴或拉贝洛尔的患者 (2.7%) 经历了 PPH。考虑到混杂因素后，在倾向评分匹配（比值比 0.77，95% CI 0.50–1.18）或分层（比值比 0.79，95% CI 0.53–1.19）分析中，CCB 暴露与 PPH 之间没有有意义的关联。多项敏感性分析得到了类似的结果。结论妊娠晚期门诊使用 CCB 治疗高血压不会增加 PPH 的风险。
ObjectiveTo determine whether outpatient exposure to calcium‐channel blockers (CCBs) at the time of delivery is associated with an increased risk for postpartum haemorrhage (PPH).DesignCohort study.SettingUnited States of America.Population or sampleMedicaid beneficiaries.MethodsWe identified a cohort of 9750 patients with outpatient prescriptions for CCBs, methyldopa, or labetalol for pre‐existing or gestational hypertension whose days of supply overlapped with delivery; 1226 were exposed to CCBs. The risk of PPH was compared in those exposed to CCBs to those exposed to methyldopa or labetalol. Propensity score matching and stratification were used to address potential confounding.Main outcome measuresThe occurrence of PPH during the delivery hospitalisation.ResultsThere were 27 patients exposed to CCBs (2.2%) and 232 patients exposed to methyldopa or labetalol (2.7%) who experienced PPH. After accounting for confounders, there was no meaningful association between CCB exposure and PPH in the propensity score matched (odds ratio 0.77, 95% CI 0.50–1.18) or stratified (odds ratio 0.79, 95% CI 0.53–1.19) analyses. Similar results were obtained across multiple sensitivity analyses.ConclusionsThe outpatient use of CCBs in late pregnancy for the treatment of hypertension does not increase the risk of PPH.