Real-World Bleeding Risk of Anticoagulant and Nonsteroidal Anti-inflammatory Drugs Combotherapy versus Anticoagulant Monotherapy.

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Gut and Liver Pub Date : 2024-09-15 Epub Date: 2024-05-10 DOI:10.5009/gnl230541

Moonhyung Lee, Jae Myung Cha

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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.

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抗凝血剂和非甾体抗炎药联合疗法与抗凝血剂单一疗法的实际出血风险。

背景/目的：随着抗凝剂和非甾体抗炎药（NSAIDs）的使用，急性胃肠道出血（GIB）的发生率会增加。本研究旨在比较抗凝剂和非甾体抗炎药联合疗法与抗凝剂单一疗法在实际应用中发生 GIB 的风险：我们使用 "通用数据模型 "调查了三家医院新处方抗凝剂和非甾体抗炎药联合疗法的患者与新处方抗凝剂单一疗法的患者发生 GIB 的相对风险。在进行倾向评分匹配后，采用 Cox 比例危险模型和 Kaplan-Meier 估计进行风险比较：对2951对匹配患者进行的综合分析表明，接受抗凝剂和非甾体抗炎药联合治疗的患者发生GIB的风险明显高于接受抗凝剂单药治疗的患者（危险比[HR]，1.66；95%置信区间[CI]，1.30~2.12；65岁以下（HR，1.53；95% CI，1.15~2.03；P=0.003）和75岁以上（HR，1.89；95% CI，1.23~2.90；P=0.003）。我们还发现，在男性队列（P=0.016）和女性队列（P=0.010）中，接受抗凝剂和非甾体抗炎药联合治疗的患者发生 GIB 的风险明显高于接受抗凝剂单药治疗的患者：结论：接受抗凝剂和非甾体抗炎药联合治疗的患者发生 GIB 的风险明显高于接受抗凝剂单一治疗的患者。此外，抗凝剂和非甾体抗炎药联合疗法导致 GIB 的风险在年龄大于 75 岁的人群中更高。因此，医生在开具抗凝剂和非甾体抗炎药处方时，应更多地了解和关注GIB的风险。

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来源期刊

Gut and Liver 医学-胃肠肝病学

CiteScore

7.50

自引率

8.80%

发文量

119

审稿时长

6-12 weeks

期刊介绍： Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut and Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. Gut and Liver is jointly owned and operated by 8 affiliated societies in the field of gastroenterology, namely: the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, the Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, the Korean Pancreatobiliary Association, and the Korean Society of Gastrointestinal Cancer.