Risk of Gastrointestinal Bleeding on Treatment With Statin Alone or With Concomitant Administration of Warfarin: A Systematic Review and Meta-analysis of 5.3 Million Participants.

The Annals of pharmacotherapy Pub Date : 2022-07-01 Epub Date: 2021-10-01 DOI:10.1177/10600280211049727
Akshaya Srikanth Bhagavathula, Kota Vidyasaga, Eyob Alemayehu Gebreyohannes, Wubshet Tesfaye
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引用次数: 1

Abstract

Objective: This study aimed to comprehensively evaluate the risk of gastrointestinal bleeding (GIB) with statin monotherapy or with concomitant warfarin use.

Data sources: PubMed, Web of Science, and EMBASE (via Scopus) were searched for observational studies that reported the risk of GIB in adults on statin therapy or with concomitant warfarin use until August 28, 2021.

Study selection and data extraction: Observational studies evaluating the risk of GIB in adults (age >18 years) on statin medication or concomitant use with warfarin were included.

Data synthesis: In all, 14 studies with a total of 5 235 123 participants, reporting 48 677 GIB events (43 734 from statin users and 4943 from users of statin combined with warfarin), were included in the analyses. The pooled analysis revealed no difference in the risk of GIB with statin monotherapy (relative risk [RR]: 0.65; 95% CI: 0.42-1.02) or concomitant statin + warfarin use (RR: 0.97; 95% CI: 0.91-1.02). Prior use of statin was not associated with GIB risk (RR: 0.88; 95% CI: 0.63-1.22), whereas a shorter duration of statin use (<5 years) was associated with a lower risk of GIB (RR: 0.42; 95% CI: 0.18-0.97).

Relevance to patient care and clinical practice: This analysis provides strong evidence on the association between statin use (with/without warfarin) and risk of GIB.

Conclusion: Statin alone or combined with warfarin was not significantly associated with either an increased or decreased risk of GIB. The GIB risk was significantly lower when statins were used for a short duration (<5 years). The putative relationship between statins and GIB in warfarin users warrant further investigation.

单独使用他汀类药物或同时使用华法林治疗胃肠道出血的风险:530万参与者的系统评价和荟萃分析
目的:本研究旨在综合评价他汀类药物单药或华法林合用胃肠道出血(GIB)的风险。数据来源:PubMed、Web of Science和EMBASE(通过Scopus)检索了报告2021年8月28日之前接受他汀类药物治疗或同时使用华法林的成人发生GIB风险的观察性研究。研究选择和数据提取:纳入了评估成人(年龄>18岁)服用他汀类药物或与华法林合用GIB风险的观察性研究。数据综合:总共纳入了14项研究,共有5 235 123名参与者,报告了48 677例GIB事件(43 734例来自他汀类药物使用者,4943例来自他汀类药物联合华法林使用者)。合并分析显示,他汀类药物单药治疗的GIB风险无差异(相对风险[RR]: 0.65;95% CI: 0.42-1.02)或同时使用他汀+华法林(RR: 0.97;95% ci: 0.91-1.02)。既往使用他汀类药物与GIB风险无关(RR: 0.88;95% CI: 0.63-1.22),而他汀类药物使用时间较短(与患者护理和临床实践相关:该分析为他汀类药物使用(联合/不联合华法林)与GIB风险之间的关联提供了强有力的证据。结论:他汀单用或联合华法林与GIB风险的增加或降低均无显著相关性。当他汀类药物使用时间较短时,GIB风险显著降低(
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