Tiên lượng của những người sử dụng đồng thời clopidogrel và thuốc ức chế bơm proton trong quần thể có nguy cơ cao bị xuất huyết tiêu hóa trên

Springer Science and Business Media LLC - Tập 15 - Trang 1-8 - 2014
Qing Wang1, Rickard Ljung1,2, Jesper Lagergren1,3, Yunxia Lu1,4
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
3Division of Cancer Studies, King’s College London, London, UK
4Department of Epidemiology and Biostatistics, Imperial College London, London, UK

Tóm tắt

Chưa rõ liệu việc sử dụng đồng thời clopidogrel và thuốc ức chế bơm proton (PPIs) có làm tăng nguy cơ tái phát bệnh tim mạch hoặc tử vong ở những bệnh nhân có nguy cơ cao bị xuất huyết tiêu hóa trên hay không. Dựa trên Đăng ký Bệnh nhân Thụy Điển, một nhóm bệnh nhân mắc bệnh tim mạch (bao gồm nhồi máu cơ tim cấp, đột quỵ và đau thắt ngực, từ năm 2006 đến 2008) đã được chọn từ một quần thể có bất kỳ chẩn đoán nào về xuất huyết tiêu hóa trên. Dữ liệu về đơn thuốc đã được thu thập từ Đăng ký Thuốc được kê đơn. Bệnh nhân được đưa vào nhóm nghiên cứu sau khi xuất viện lần đầu về bệnh tim mạch và được theo dõi cho đến khi tử vong, tái phát bệnh tim mạch, hoặc trong vòng 90 ngày. Một mô hình hồi quy Cox đã được thực hiện và tỷ lệ nguy cơ (HRs) với khoảng tin cậy 95% (CIs) đã được ước lượng để đánh giá các rủi ro giữa những người sử dụng các loại thuốc kê đơn khác nhau. Những bệnh nhân vẫn đang sử dụng duy nhất PPIs (HR 2.02, 95% CI 1.19-3.44), chỉ clopidogrel (HR 1.14, 95% CI 0.53-2.45) và những người không sử dụng cả hai (HR 2.36, 95% CI 1.39-4.00) có nguy cơ tử vong cao hơn so với những bệnh nhân có sử dụng đồng thời. Kết quả tương tự được ghi nhận среди 1779 bệnh nhân có lịch sử xuất huyết tiêu hóa trên (HR 2.05, 95% CI 1.18-3.54; HR 1.25, 95% CI 0.57-2.72; HR 2.30, 95% CI 1.33-3.98, tương ứng). Trong số những bệnh nhân có nguy cơ cao bị xuất huyết tiêu hóa trên, những người có sử dụng đồng thời PPIs và clopidogrel có nguy cơ tử vong giảm, và có thể cũng nguy cơ tái phát bệnh tim mạch giảm.

Từ khóa

#clopidogrel #thuốc ức chế bơm proton #xuất huyết tiêu hóa trên #bệnh tim mạch #nguy cơ tử vong

Tài liệu tham khảo

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