目的:药效学药物相互作用(PDDDIs)可能会影响非维生素K拮抗剂口服抗凝药(NOACs)的安全性,但是PDDDIs增加出血风险的程度,尚不清楚。因此,在NOAC治疗的房颤(AF)患者中,研究了PDDDIs对出血结局的影响.
方法:使用比利时全国数据,2013-2019年间纳入NOAC治疗的房颤患者。确定在开始NOAC治疗时同时使用PD相互作用药物。
结果:在193,072名患者中,在114,122名(59.1%)受试者中鉴定出PDDDI。经过多变量调整后,伴随使用PD相互作用药物与严重或临床相关的非严重出血的风险显着升高相关(调整后的风险比(aHR)1.19,95%置信区间(CI)(1.13-1.24)),胃肠道(AHR1.12,95CI(1.03-1.22)),泌尿生殖系统(AHR1.21,95CI(1.09-1.35))和其他出血(AHR1.28,95CI(1.20-1.36)),与未使用PD相互作用药物的NOAC治疗的AF患者相比。P2Y12抑制剂(aHR1.62,95CI(1.48-1.77))和皮质类固醇(aHR1.53,95CI(1.42-1.66))的出血风险增加最为明显,其次是选择性5-羟色胺或5-羟色胺和去甲肾上腺素再摄取抑制剂(SSRI/SNRI,aHR1.26,95CI(1.17-1.35)),低剂量阿司匹林(aHR1.14,95CI(1.08-1.20))和非甾体抗炎药(NSAID,AHR1.10,95CI(1.01-1.21))。使用SSRI/SNRIs(aHR1.50,95CI(1.25-1.81))和皮质类固醇(aHR1.49,95CI(1.21-1.84))观察到NOAC使用者的颅内出血风险明显更高。
结论:伴随使用PD相互作用药物,尤其是P2Y12抑制剂和皮质类固醇,与更高的专业有关,胃肠,泌尿生殖系统,NOAC治疗的房颤患者的其他出血风险。值得注意的是,SSRI/SNRIs和皮质类固醇的颅内出血风险较高.
OBJECTIVE: Pharmacodynamic drug-drug interactions (PD DDIs) may influence the safety of non-vitamin K antagonist oral anticoagulants (NOACs), but the extent to which PD DDIs increase bleeding risks, remains unclear. Therefore, the impact of PD DDIs on bleeding outcomes in
NOAC-treated patients with atrial fibrillation (AF) was investigated.
METHODS: Using Belgian nationwide data,
NOAC-treated AF patients were included between 2013-2019. Concomitant use of PD interacting drugs when initiating
NOAC treatment was identified.
RESULTS: Among 193,072 patients, PD DDIs were identified in 114,122 (59.1%) subjects. After multivariable adjustment, concomitant use of PD interacting drugs was associated with significantly higher risks of major or clinically-relevant non-major bleeding (adjusted hazard ratio (aHR) 1.19, 95% confidence interval (CI) (1.13-1.24)), gastrointestinal (aHR 1.12, 95%CI (1.03-1.22)), urogenital (aHR 1.21, 95%CI (1.09-1.35)) and other bleeding (aHR 1.28, 95%CI (1.20-1.36)), compared to
NOAC-treated AF patients without PD interacting drug use. Increased bleeding risks were most pronounced with P2Y12 inhibitors (aHR 1.62, 95%CI (1.48-1.77)) and corticosteroids (aHR 1.53, 95%CI (1.42-1.66)), followed by selective serotonin or serotonin and norepinephrine reuptake inhibitors (SSRI/SNRI, aHR 1.26, 95%CI (1.17-1.35)), low-dose aspirin (aHR 1.14, 95%CI (1.08-1.20)) and non-steroidal anti-inflammatory drugs (NSAID, aHR 1.10, 95%CI (1.01-1.21)). Significantly higher intracranial bleeding risks in
NOAC users were observed with SSRI/SNRIs (aHR 1.50, 95%CI (1.25-1.81)) and corticosteroids (aHR 1.49, 95%CI (1.21-1.84)).
CONCLUSIONS: Concomitant use of PD interacting drugs, especially P2Y12 inhibitors and corticosteroids, was associated with higher major, gastrointestinal, urogenital, and other bleeding risks in NOAC-treated AF patients. Remarkably, higher intracranial bleeding risks were observed with SSRI/SNRIs and corticosteroids.