Неаспириновые нестероидные противовоспалительные препараты и риск развития геморрагического инсульта. Систематический обзор и мета-анализ обсервационных исследований


П. Унгпрасерт, Е.Л. Маттесон, К. Тонгпрайоон

Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN и Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Предпосылки и цель исследования. Ассоциация между геморрагическим инсультом и приемом нестероидных противовоспалительных средств (НПВС) изучена недостаточно. Мы провели систематический обзор и мета-анализ обсервационных исследований для определения этой возможной связи. Методы. Провели систематический поиск исследований дизайна случай-контроль и когортных исследований с предоставленными данными об отношении шансов, относительном риске, отношении рисков или стандартизованной заболеваемости геморрагическим инсультом среди лиц, принимавших НПВС, по сравнению с лицами, не принимавших подобные препараты. Из каждого исследования извлекли данные о точечных оценках. С использованием метода случайных эффектов стандартной обратной дисперсии рассчитали обобщенные отношения рисков (ОР) и 95% доверительные интервалы (ДИ) для всех НПВС и отдельных НПВС. Результаты.
В анализ включили данные выявленных десяти исследований. В качестве единой группы, применение НПВС было ассоциировано ­
с небольшим, но незначительно повышенным риском развития геморрагического инсульта, при этом обобщенное ОР составило 1,09 ­
(95% ДИ от 0,98 до 1,22). При анализе отдельных НПВС выявили статистически значимое повышение риска среди лиц, принимающих диклофенак и мелоксикам (ОР=1,27, 95% ДИ от 1,02 до 1,59 и ОР=1,27, 95% ДИ от 1,08 до 1,50 соответственно). Риск среди лиц, принимавших рофекоксиб, был высоким, но статистически недостоверным (ОР=1,35, 95% ДИ от 0,88 до 2,06). Выводы. В целом использование НПВС не ассоциировано с повышенным риском развития геморрагического инсульта, но среди лиц, принимающих диклофенак и мелоксикам, этот риск достоверно выше.

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