Real-World Bleeding Risk of Anticoagulant and Nonsteroidal Anti-inflammatory Drugs Combotherapy versus Anticoagulant Monotherapy
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: The incidence of acute gastrointestinal bleeding (GIB) increases with the utilization of anticoagulant and nonsteroidal anti-inflammatory drugs (NSAIDs). This study aimed to compare the risk of GIB between anticoagulant and NSAIDs combotherapy and anticoagulant monotherapy in real-world practice. Methods: We investigated the relative risk of GIB in individuals newly prescribed anticoagulant and NSAIDs combination therapy and that in individuals newly prescribed anticoagulant monotherapy at three hospitals using “common data model.” Cox proportional hazard models and Kaplan-Meier estimation were employed for risk comparison after propensity score matching. Results: A comprehensive analysis of 2,951 matched pairs showed that patients who received anticoagulant and NSAIDs combousers exhibited a significantly higher risk of GIB than those who received anticoagulant monousers (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.30 to 2.12; p<0.001). The risk of GIB associated with anticoagulant and NSAIDs combination therapy was also significantly higher than that associated with anticoagulant monotherapy in patients aged >65 years (HR, 1.53; 95% CI, 1.15 to 2.03; p=0.003) and >75 years (HR, 1.89; 95% CI, 1.23 to 2.90; p=0.003). We also found that the risk of GIB was significantly higher in the patients who received anticoagulant and NSAIDs combousers than that in patients who received anticoagulant monousers in both male (p=0.016) and female cohorts (p=0.010). Conclusions: The risk of GIB is significantly higher in patients who receive anticoagulant and NSAIDs combotherapy than that in patients who receive anticoagulant monotherapy. In addition, the risk of GIB associated with anticoagulant and NSAIDs combotherapy was much higher in individuals aged >75 years. Therefore, physicians should be more aware of pay more attention to the risk of GIB when they prescribe anticoagulant and NSAIDs.
Abstract
Background/Aims: The incidence of acute gastrointestinal bleeding (GIB) increases with the utilization of anticoagulant and nonsteroidal anti-inflammatory drugs (NSAIDs). This study aimed to compare the risk of GIB between anticoagulant and NSAIDs combotherapy and anticoagulant monotherapy in real-world practice. Methods: We investigated the relative risk of GIB in individuals newly prescribed anticoagulant and NSAIDs combination therapy and that in individuals newly prescribed anticoagulant monotherapy at three hospitals using “common data model.” Cox proportional hazard models and Kaplan-Meier estimation were employed for risk comparison after propensity score matching. Results: A comprehensive analysis of 2,951 matched pairs showed that patients who received anticoagulant and NSAIDs combousers exhibited a significantly higher risk of GIB than those who received anticoagulant monousers (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.30 to 2.12; p<0.001). The risk of GIB associated with anticoagulant and NSAIDs combination therapy was also significantly higher than that associated with anticoagulant monotherapy in patients aged >65 years (HR, 1.53; 95% CI, 1.15 to 2.03; p=0.003) and >75 years (HR, 1.89; 95% CI, 1.23 to 2.90; p=0.003). We also found that the risk of GIB was significantly higher in the patients who received anticoagulant and NSAIDs combousers than that in patients who received anticoagulant monousers in both male (p=0.016) and female cohorts (p=0.010). Conclusions: The risk of GIB is significantly higher in patients who receive anticoagulant and NSAIDs combotherapy than that in patients who receive anticoagulant monotherapy. In addition, the risk of GIB associated with anticoagulant and NSAIDs combotherapy was much higher in individuals aged >75 years. Therefore, physicians should be more aware of pay more attention to the risk of GIB when they prescribe anticoagulant and NSAIDs.
참고문헌 (24)
- Aljarad Z, "The mortality rate among patients with acute upper GI bleeding(with", without EGD)at Aleppo University Hospital : a retrospective study, 2021, pp.71, 102958~
- Benamouzig R, "Review article : gastrointestinal bleeding risk with direct oral anticoagulants", Cardiovasc Drugs Ther, 36, pp.973~989 (2022)
- Zappulla P, "Gastrointestinal bleeding and direct oral anticoagulants among patients with atrial fibrillation : risk, prevention, management, and quality of life", TH Open, 5, pp.e200~e210 (2021)
- Kent AP, "Concomitant oral anticoagulant and nonsteroidal anti-inflammatory drug therapy in patients with atrial fibrillation", J Am Coll Cardiol, 72, pp.255~267 (2018)
- Dalgaard F, "Patients with atrial fibrillation taking nonsteroidal anti-inflammatory drugs and oral anticoagulants in the ARISTOTLE trial", Circulation, 141, pp.10~20 (2020)
- Lee YJ, "Use of novel oral anticoagulants for the treatment of venous thromboembolism and its considerations in Asian patients", Ther Clin Risk Manag, 10, pp.841~850 (2014)
- Lee SY, "Differences in managing anticoagulants and antiplatelets for gastrointestinal endoscopy between East and West", Gastroenterology Res, 2, pp.67~80 (2009)
- Gisbert JP, "Long-term follow-up of 1, 000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding", Am J Gastroenterol, 107, pp.1197~1204 (2012)
- Hripcsak G, "Observational Health Data Sciences and Informatics(OHDSI) : opportunities for observational researchers", Stud Health Technol Inform, 216, pp.574~578 (2015)
- Overhage JM, "Validation of a common data model for active safety surveillance research", J Am Med Inform Assoc, 19, pp.54~60 (2012)
- Yoon D, "Conversion and data quality assessment of electronic health record data at a Korean tertiary teaching hospital to a common data model for distributed network research", Healthc Inform Res, 22, pp.54~58 (2016)
- Seo SI, "Association between proton pump inhibitor use and gastric cancer : a population-based cohort study using two different types of nationwide databases in Korea", Gut, 70, pp.2066~2075 (2021)
- Reich C, "Evaluation of alternative standardized terminologies for medical conditions within a network of observational healthcare databases", J Biomed Inform, 45, pp.689~696 (2012)
- Siddique SM, "Rates of hospital readmission among Medicare beneficiaries with gastrointestinal bleeding vary based on etiology and comorbidities", Clin Gastroenterol Hepatol, 17, pp.90~97 (2019)
- Abraham NS, "Gastrointestinal safety of direct oral anticoagulants : a large population-based study", Gastroenterology, 152, pp.1014~1022 (2017)
- Massó González EL, "Variability among nonsteroidal antiinflammatory drugs in risk of upper gastrointestinal bleeding", Arthritis Rheum, 62, pp.1592~1601 (2010)
- Villa Zapata L, "Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs : a systematic review and meta-analysis", Thromb Haemost, 120, pp.1066~1074 (2020)
- Sagris D, "Bleeding risk comparison between direct oral anticoagulants at doses approved for atrial fibrillation and aspirin : systematic review, meta-analysis and meta-regression", Eur J Intern Med, 79, pp.31~36 (2020)
- Eikelboom JW, "Major bleeding in patients with coronary or peripheral artery disease treated with rivaroxaban plus aspirin", J Am Coll Cardiol, 74, pp.1519~1528 (2019)
- Dong Y, "Prevention of non-vitamin K oral anticoagulants-related gastrointestinal bleeding with acid suppressants : a systematic review and meta-analysis", Clin Appl Thromb Hemost, 28, pp.10760296211064897~ (2022)
- Kurlander JE, "Association of antisecretory drugs with upper gastrointestinal bleeding in patients using oral anticoagulants : a systematic review and meta-analysis", Am J Med, 135, pp.1231~1243 (2022)
- Kang JK, "Association of Helicobacter pylori with gastritis and peptic ulcer diseases", Yonsei Med J, 32, pp.157~168 (1991)
- Malaty HM, "Prevalence of Helicobacter pylori infection in Korean children : inverse relation to socioeconomic status despite a uniformly high prevalence in adults", Am J Epidemiol, 143, pp.257~262 (1996)
- Venerito M, "Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti-inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors", Aliment Pharmacol Ther, 47, pp.1464~1471 (2018)