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相關文獻
- 臺灣抗凝血西藥及非類固醇止痛藥與科學中藥併用及交互作用之藥物流行病學研究
- Using Taiwan's National Health Insurance Research Databases for Pharmacoepidemiology Research
- 全民健保資料庫的抽樣方法
- Pharmacoepidemiology藥物流行病學--clinical pharmacology(臨床藥理學)和epidemiology(流行病學)結合而產生的一門新學科
- Warfarin的交互作用
- 藥物流行病學
- 低分子量肝素於血液透析的應用
- 抗凝血藥物的新發展
- Warfarin用藥指導
- 藥物流行病學簡介
頁籤選單縮合
題名 | 臺灣抗凝血西藥及非類固醇止痛藥與科學中藥併用及交互作用之藥物流行病學研究=Causal Inference of Bleeding Complications in Patients with Warfarin Treatment in Taiwan-a Eleven Year Follow up Study |
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作者 | 賴榮年; Lai, Jung-nien; |
期刊 | 中醫藥年報 |
出版日期 | 20100900 |
卷期 | 28:8 2010.09[民99.09] |
頁次 | 頁291-388 |
分類號 | 418.2 |
語文 | chi |
關鍵詞 | 抗凝血藥物; 非類固醇止痛藥; 中西藥併用交互作用; 全民健保資料庫; 藥物流行病學; Anticoagulant drug; Non Steroid Antiinflammatory Drug-herb interaction; Pharmacoepidemiology; |
中文摘要 | 研究目的: 本研究針對近十一年國人使用抗凝血西藥warfarin併用中藥狀況,進行藥物交互作用及藥物流行病學調查,敘述目前抗凝血西藥warfarin與中藥併用概況,並提供此類中西藥交互作用是否會導致急性腸胃出血住院或急性腦出血住院副作用之實證資料,以維護國人用藥安全。 研究方法: 本研究是以全民健康保險研究資料庫中2005年的100萬健保抽樣歸人 檔,其1997-2007年所有健保承保資料檔為母群體,作為研究材料。並採用病 例交叉研究方法探討服用抗凝血藥物warfarin及中藥併用狀況進行因果分析。 主要發現:本研究結果顯示急性腸胃道出血住院風險方面,warfarin 併用下列三組一級交互作用藥物其原始勝算比有顯著差異,各為celecoxib (OR:6.86, 95% CI:1.33-35.39)、ketoprofen (OR:4.46, 95% CI:1.05-18.95)、 noscapine (OR:4.53, 95% CI:1.11-18.48)。將此三種藥物一起納入迴歸分析, 其校正後勝算比僅warfarin併用celecoxib (OR:6.86, 95% CI:1.33-35.39) 顯著增 加腸胃道出血住院的風險。急性腦出血住院風險方面,warfarin併用下列兩 組藥物其原始勝算比有顯著差異,各為aspirin (OR:1.94, 95% CI:1.06-3.58)、 clopodogrel (OR:7.3, 95% CI:1.45-36.73)。將此兩種藥物一起納入迴歸分析, 其校正後勝算比仍顯示warfarin併用aspirin (OR:1.90, 95% CI:1.03-3.52)或併 用clopodogrel (OR:7.15, 95% CI:1.41-36.26) 顯著增加腦出血住院的風險。而 warfarin併用中藥使用方面:不論急性胃腸出血或腦出血,其勝算比均沒有顯示增加住院之風險。 結論與建議: 本研究發現了warfarin併用celecoxib增加了急性胃腸出血住院風險;warfarin併用aspirin、clopidogrel增加了急性腦出血住院之風險,並且在70歲 以上的年齡族群有最高的發生風險,建議對於高齡族群,同日合併使用抗凝 血coumarin類西藥與celecobib、ketoprofen、noscapine、aspirin、clopidogrel, 需嚴密監控其凝血狀態。在中藥使用方面:本研究結果顯示,包括當歸、人參、白芍、牛膝、川芎等中藥,含有如coumarin的中藥,並沒有增加急性 胃腸出血住院、急性腦出血住院之風險。當然,無法排除持續暴露的時間較短,累積劑量亦較低,故風險原本就不高;再加上抗凝血西藥與含抗凝血作 用或成分之中藥併用的人數不多,併用中藥的累積劑量低等因素,而產生如此的結論,建議延長觀察的時間或許更能準確的計算其中西藥交互作用的風險。 |
英文摘要 | Background and Aim: Drug interaction is one of the most important issues in drug safety. When the Chinese herbal medicines (CHMs) become more popular, these herbs are often co- administered with therapeutic drugs raising the potential of drug–herb interactions, which may have important clinical significance based on an increasing number of clinical reports of such interactions. The interaction between herbs and drugs with narrow therapeutic indices (e.g. warfarin) is a significant safety concern. Because the pharmacokinetics and/or pharmacodynamics of the drug may be altered by combination with herbal remedies, potentially severe and perhaps even life- threatening adverse reactions may occur. In the other way. But there is still lack the solid data of the drug-herb interaction of these drugs. Our research will provide the causal inference of the these kinds of drug herb co-administered in national health insurance system. We also try to find out the severe adverse due to these drug- herb interactions in the national health insurance cohort 1997-2007. We hope this research can help our government to built a safe TCM environment. Method: A case-crossover study was designed on 1,000,000 randomly selected individuals from the National Health Insurance Research Database who were then followed from 1997 to 2007. All medications taken in the 90-day period prior to hospitalization was explored and compared with three control periods (the 180- ,270-and 360-day periods prior to the hospitalization). A conditional logistic regression model was then constructed to determine the odds of CHMs being prescribed during these risk periods. Result : During the study period, we identified 4,211 patients receiving warfarin. Of those, 299 (7.1%) were admitted to the hospital with GI hemorrhage. After adjusting for other potential confounders, case patients were significantly more likely to be also taking celecoxib (OR, 6.86; 95%CI, 1.33-35.39) prior to hospitalization relative to controls. And of those 4,211 patients receiving warfarin, 312 (7.4%) were admitted to the hospital with cerebrovascular hemorrhage. After adjusting for other potential confounders, case patients were significantly more likely to be also taking aspirin (OR, 1.90; 95%CI, 1.03-3.52) and clopidogrel (OR, 7.15; 95%CI, 1.41-36.26) prior to hospitalization relative to controls. Chinese herbal users revealed no increased risk of GI hemorrhage and cerebrovascular hemorrhage. Conclusions: Patients taking warfarin concomitantly with selective COX-2 inhibitors(celecoxib) have an increased risk of hospitalization for GI hemorrhage. Then patients taking warfarin concomitantly with aspirin and/or clopidogrel have an increased risk of hospitalization for cerebrovascular hemorrhage. The present study did not show that CHMs have an increased risk of hospitalization for GI hemorrhage and cerebrovascular hemorrhage. |
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