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Heart：口服抗凝剂引起肝损伤而住院风险谁很低？

2017-01-07 xing.T MedSci原创

肝损伤住院口服抗凝剂
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在非瓣膜性房颤患者中，与华法林相比，DOACs与较低的肝损伤住院风险相关，服用达比加群引起的肝损伤住院风险最低。

近日，在心脏病领域权威期刊Heart上发表了一篇研究文章，研究人员旨在评估房颤患者开始服用直接口服抗凝药（DOACs）或华法林后发生肝损伤而住院的风险，以及确定这一人群中因肝损伤而住院的预测因子。

研究人员分析了113,717例被纳入了MarketScan商业医疗保险补充数据库的房颤患者（平均年龄为70岁，39%为女性），这些患者在2011年11月4日开始口服抗凝药物治疗，并随访至2014年12月31日。其中，56,879名参与者开始服用华法林，17286名参与者开始服用达比加群，30,347名参与者服用利伐沙班和9205名参与者服用阿哌沙班。参与者肝损伤住院治疗和并发症通过医疗索赔来确定。

在中位随访的12个月期间，960例参与者因肝损伤而住院治疗。口服抗凝药引起的肝损伤住院率（每1000人每年）分别为9人（华法林）、4人（达比加群）、6.6人（利伐沙班）和5.6人（阿哌沙班）。进行多变量调整后，服用DOACs引起的肝损伤住院率比服用华法林的参与者要低：风险比（95%可信区间）分别为：达比加群为0.57（0.46-0.71）、利伐沙班为0.88（0.75-1.03）和阿哌沙班为0.70（0.50-0.97）。与服用达比加群相比，服用利伐沙班引起肝损伤而住院的风险增加了56%（风险比为1.56，95%可信区间为1.22-1.99）。除了抗凝剂的类型，既往肝脏、胆囊和肾脏疾病、癌症、贫血、心力衰竭和酗酒都能显著预测肝损伤住院。包括这些变量的预测模型具有足够的鉴别能力（c统计值为0.67，95%可信区间为0.64-0.70）。

由此可见，在非瓣膜性房颤患者中，与华法林相比，DOACs与较低的肝损伤住院风险相关，服用达比加群引起的肝损伤住院风险最低。

原始出处：

Alvaro Alonso,et al. Prospective study of oral anticoagulants and risk of liver injury in patients with atrial fibrillation. Heart. 2017. 

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    2017-01-09 bluefate121

    #住院风险#

    0

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    2017-01-09 gdsun

    #口服抗凝剂#

    0

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    2017-01-09 12498bd5m16暂无昵称

    #肝损伤#

    0

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    2017-01-09 zhaojie88

    #ART#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1251706, encodeId=6e321251e0676, content=<a href='/topic/show?id=fab72646628' target=_blank style='color:#2F92EE;'>#住院风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26466, encryptionId=fab72646628, topicName=住院风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93e223, createdName=bluefate121, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1309725, encodeId=8ce31309e25d4, content=<a href='/topic/show?id=886438210fb' target=_blank style='color:#2F92EE;'>#口服抗凝剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38210, encryptionId=886438210fb, topicName=口服抗凝剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed25376, createdName=gdsun, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1338763, encodeId=9fe51338e63b4, content=<a href='/topic/show?id=9d3d812280b' target=_blank style='color:#2F92EE;'>#肝损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81228, encryptionId=9d3d812280b, topicName=肝损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356147, encodeId=dd84135614e7f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397119, encodeId=75ac139e119ce, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562414, encodeId=ca2e1562414bb, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168938, encodeId=5a13168938c6, content=以前真没注意过，学习了，多谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Sun Jan 08 23:15:51 CST 2017, time=2017-01-08, status=1, ipAttribution=)]
    2017-01-09 ms3046638856685384

    #损伤#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1251706, encodeId=6e321251e0676, content=<a href='/topic/show?id=fab72646628' target=_blank style='color:#2F92EE;'>#住院风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26466, encryptionId=fab72646628, topicName=住院风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93e223, createdName=bluefate121, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1309725, encodeId=8ce31309e25d4, content=<a href='/topic/show?id=886438210fb' target=_blank style='color:#2F92EE;'>#口服抗凝剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38210, encryptionId=886438210fb, topicName=口服抗凝剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed25376, createdName=gdsun, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1338763, encodeId=9fe51338e63b4, content=<a href='/topic/show?id=9d3d812280b' target=_blank style='color:#2F92EE;'>#肝损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81228, encryptionId=9d3d812280b, topicName=肝损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356147, encodeId=dd84135614e7f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397119, encodeId=75ac139e119ce, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562414, encodeId=ca2e1562414bb, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168938, encodeId=5a13168938c6, content=以前真没注意过，学习了，多谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Sun Jan 08 23:15:51 CST 2017, time=2017-01-08, status=1, ipAttribution=)]
    2017-01-09 slcumt

    #HEART#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1251706, encodeId=6e321251e0676, content=<a href='/topic/show?id=fab72646628' target=_blank style='color:#2F92EE;'>#住院风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26466, encryptionId=fab72646628, topicName=住院风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93e223, createdName=bluefate121, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1309725, encodeId=8ce31309e25d4, content=<a href='/topic/show?id=886438210fb' target=_blank style='color:#2F92EE;'>#口服抗凝剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38210, encryptionId=886438210fb, topicName=口服抗凝剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed25376, createdName=gdsun, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1338763, encodeId=9fe51338e63b4, content=<a href='/topic/show?id=9d3d812280b' target=_blank style='color:#2F92EE;'>#肝损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81228, encryptionId=9d3d812280b, topicName=肝损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356147, encodeId=dd84135614e7f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397119, encodeId=75ac139e119ce, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562414, encodeId=ca2e1562414bb, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jan 09 12:39:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168938, encodeId=5a13168938c6, content=以前真没注意过，学习了，多谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Sun Jan 08 23:15:51 CST 2017, time=2017-01-08, status=1, ipAttribution=)]
    2017-01-08 1e1263e3m20(暂无匿称)

    以前真没注意过，学习了，多谢分享

    0