| アブストラクト | PURPOSE: Incidence of bleeding amongst warfarin and direct oral anticoagulant (DOAC) users is greater following a respiratory tract infection (RTI). It is unclear whether immediate antibiotics modify this association. We estimated the risk of bleeding amongst warfarin and DOAC users with RTI by antibiotic treatment. METHODS: This retrospective cohort study used data from the Clinical Practice Research Datalink (CPRD) GOLD for adults in England prescribed warfarin or a DOAC, who sought primary care for an RTI between 1st January 2011 and 31st December 2019. Outcomes were major bleeding (hospital admission for intracranial or gastrointestinal bleeding), and non-major bleeding (hospital admission or General Practice consult for epistaxis, haemoptysis, or haematuria). Cox models derived hazard ratios (HRs) and 95% confidence intervals (CIs) for each outcome, adjusting for confounders using inverse probability of treatment weighting. RESULTS: Of 14 817 warfarin and DOAC users consulting for an RTI, 8768 (59%) were prescribed immediate antibiotics and 6049 (41%) were not. Approximately 49% were female, and median age was 76 years. Antibiotics were associated with reduced risk of major bleeding (adjusted HR 0.38, 95% CI 0.25 to 0.58). This was consistent across several sensitivity analyses. Antibiotics were also associated with a reduced risk of non-major bleeding (adjusted HR 0.78, 95% CI 0.61 to 0.99). CONCLUSIONS: Immediate antibiotics were associated with reduced risk of bleeding amongst warfarin and DOAC users with an RTI. Further work is needed to understand mechanisms and confirm whether a lower threshold for antibiotic use for RTI in this population may be beneficial. |
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| ジャーナル名 | Pharmacoepidemiology and drug safety |
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| 投稿日 | 2024/4/29 |
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| 投稿者 | Ahmed, Haroon; Reeve, Nicola; Farewell, Daniel; Hamilton, Fergus; Ponsford, Mark; Hippisley-Cox, Julia; Noble, Simon |
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| 組織名 | Division of Population Medicine, Cardiff University School of Medicine, Cardiff,;UK.;MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.;Division of Infection and Immunity, Cardiff University School of Medicine,;Cardiff, UK.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38680080/ |
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