未经证实:苯二氮卓类药物与肝硬化患者的伤害风险增加相关。然而,停用苯二氮卓类药物时必须小心避免戒断或其他意外后果.取消处方对肝硬化患者的影响尚不清楚。
UNASSIGNED:我们在缺乏其他生命限制诊断的代偿性肝硬化的Medicare参与者中模拟了苯二氮卓类药物处方的假设3年试验。所有患者在诊断为肝硬化之前的6个月内连续接受苯二氮卓类药物处方。在他们诊断为肝硬化后的90天具有里程碑意义的时期,患者被归类为完全停用药物者(未分配苯二氮卓类药物),连续用户,或部分开处方者。我们使用逆概率治疗加权将完全开处方者与传统苯二氮卓类药物和唑吡坦的连续使用者进行比较。结果占死亡的竞争风险,并包括事件代偿失调(肝性脑病,腹水,或静脉曲张出血),骨折,falls,和酒精相关的住院。
UNASSIGNED:有1,651和1,463名传统苯二氮卓类药物和唑吡坦的连续用户,分别,和728名完全戒断处方者。患者的年龄中位数为68岁,24%患有酒精相关性肝硬化。连续使用者和开处方者的死亡或失代偿风险没有差异。在传统苯二氮卓类药物的开药者中,跌倒或骨折的风险没有改善.然而,与连续唑吡坦用户相比,开处方者跌倒的风险较低(23.2%vs.31%,p=0.04)和骨折(21%与29%,p=0.02)。
未经评估:停用唑吡坦可降低跌倒和骨折的风险。然而,停用苯二氮卓类药物并不能改善失代偿的风险.迫切需要努力安全地解决苯二氮卓类药物的适应症,例如失眠和焦虑。
未经证实:许多肝硬化患者有焦虑,抑郁症,和睡眠障碍。越来越多,肝硬化患者使用称为苯二氮卓类药物的镇静药物治疗,包括安定,阿普唑仑(\'Xanax\'),clonopin,和睡眠辅助唑吡坦(\'Ambien\'),会导致跌倒,骨折,也许还有其他脑部疾病.出于这个原因,许多研究人员对“去处方”(停止)苯二氮卓类药物的试验感兴趣。然而,尚未进行试验.我们使用健康记录数据来模拟取消处方的试验。我们发现停止苯二氮卓类药物可以减少跌倒或骨折的机会,但它不能改善生存率或肝脏健康。
UNASSIGNED: Benzodiazepines are associated with an increased risk of harm in patients with cirrhosis. However, stopping benzodiazepines must be done with care to avoid withdrawal or other unintended consequences. The impact of deprescribing on patients with cirrhosis is unknown.
UNASSIGNED: We emulated a hypothetical 3-year trial of benzodiazepine deprescription among Medicare enrollees with compensated cirrhosis who lacked other life-limiting diagnoses. All received continuous benzodiazepine prescriptions for the 6-months prior to their diagnosis of cirrhosis. During a 90-day landmark period following their diagnosis of cirrhosis, patients were classified as complete deprescribers (no benzodiazepines dispensed), continuous users, or partial deprescribers. We used inverse probability treatment weighting to compare complete deprescribers to continuous users of traditional benzodiazepines and zolpidem. Outcomes accounted for competing risk of mortality and included incident decompensation (hepatic encephalopathy, ascites, or variceal bleeding), fractures, falls, and alcohol-related hospitalizations.
UNASSIGNED: There were 1,651 and 1,463 continuous users of traditional benzodiazepines and zolpidem, respectively, and 728 complete deprescribers. Patients were aged a median of 68 years, 24% had alcohol-related cirrhosis. There was no difference in the risk of death or decompensation for continuous users and deprescribers. Among deprescribers of traditional benzodiazepines, there was no improvement in the risk of falls or fractures. However, compared to continuous zolpidem users, deprescribers had a lower risk of falls (23.2% vs. 31%, p = 0.04) and fractures (21% vs. 29%, p = 0.02).
UNASSIGNED: Deprescribing zolpidem reduces the risk of falls and fractures. However, deprescribing benzodiazepines does not improve the risk of decompensation. Efforts to safely address the indications for benzodiazepines such as insomnia and anxiety are urgently needed.
UNASSIGNED: Many people with cirrhosis have anxiety, depression, and sleep disorders. Increasingly, patients with cirrhosis are treated with sedating medications called benzodiazepines, including valium, alprazolam (\'Xanax\'), clonopin, and the sleep-aid zolpidem (\'Ambien\'), which can cause falls, broken bones, and maybe other brain disorders. For this reason, many researchers are interested in trials of \'deprescribing\' (stopping) benzodiazepines. However, no trials have been performed. We used health record data to simulate a trial of deprescribing. We found that stopping benzodiazepines may reduce the chance of falls or broken bones, but it does not improve survival or liver health.