2014-年-3-月非甾体类抗炎药在心血管疾病患者中合理使用蔡宏文.pdf.docVIP

非甾体类抗炎药在心血管疾病患者中的合理使用 蔡宏文1 ，徐慧敏2* ( 1. 浙江中医药大学附属第一医院心内科，杭州 310006; 2. 浙江大学医学院附属第二医院药剂科，杭州 310009) 摘要: 目的 为非甾体类抗炎药( nonsteroidal anti-inflammatory drugs，NSAIDs) 在心血管疾病患者中的合理应用提供用药指导。 方法 阐述非甾体类抗炎药引起心血管风险的机制，综述国内外关于不同非甾体类抗炎药心血管风险比较的临床研究和荟 萃分析结果。结果 所有的非甾体类抗炎药均有可能增加心血管不良反应。不同非甾体类抗炎药的心血管风险与环氧酶-2 选择性、是否干扰小剂量阿司匹林的抗血小板作用等有关。结论 临床上在心血管疾病患者中使用非甾体类抗炎药时，应充 分评估其治疗获益和心血管风险，严格掌握其适应证和禁忌证，合理选择不同种类的非甾体类抗炎药，注意与阿司匹林的药 物相互作用，加强用药监测，避免不良事件发生。 关键词: 非甾体类抗炎药; 心血管疾病; 环氧酶; 心血管风险; 合理用药 doi:10. 11669 /cpj. 2014. 06. 020 中图分类号: Ｒ95 文献标志码: A 文章编号: 1001 － 2494( 2014) 06 － 0512 － 05 Use of Nonsteroidal Antiinflammatory Drugs in Patients with Cardiovascular Disease 1 ， 2* CAI Hong-wen XU Hui-min ( 1. Department of Cardiovascular Medicine，The First Affiliated Hospital，Zhejiang Chinese Medi-cal University，Hangzhou 310006，China; 2. Department of Pharmacy，The Second Affiliated Hospital，School of Medicine，Zhejiang U-niversity，Hangzhou 310009，China) ABSTＲACT: OBJECTIVE To provide appropriate guidelines to optimize the rational use of nonsteroidal anti-inflammatory drugs ( NSAIDs) for patients with established cardiovascular disease ( CVD) . METHODS Mechanisms of increased CVD risk due to NSAIDs were elaborated. Ｒesults of clinical researches and Meta-analysis for different NSAIDs in CVD risk were reviewed. ＲESULTS All NSAIDs are associated with an increased risk of cardiovascular adverse effects. The degree of selectivity for cyclooxygenase-2 and the interaction with low-dose aspirin may contribute to the CVD risk of different NSAIDs. CONCLUSION Physicians should weigh the benefits against risks for individual patients with CVD. NSAIDs should be used in strict accordance with indications and contraindi-cations. Appropriate class of NSAIDs should be selected and interaction with aspirin should be avoided in patients with CVD. After the prescription of NSAIDs，the patients should be monitored to minimize the adverse effects. KEY WOＲDS: nonsteroidal anti-inflammatory drug; cardiovascular disease