{"id":4153,"date":"2019-03-09T23:05:06","date_gmt":"2019-03-09T16:05:06","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=4153"},"modified":"2019-03-09T23:06:48","modified_gmt":"2019-03-09T16:06:48","slug":"jama-nghien-cuu-da-trung-tam-ve-moi-lien-he-giua-ti-le-tu-vong-tai-benh-vien-o-benh-nhan-xuat-huyet-trong-nao-voi-viec-su-dung-thuoc-chong-dong-duong-uong","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/jama-nghien-cuu-da-trung-tam-ve-moi-lien-he-giua-ti-le-tu-vong-tai-benh-vien-o-benh-nhan-xuat-huyet-trong-nao-voi-viec-su-dung-thuoc-chong-dong-duong-uong\/","title":{"rendered":"JAMA: nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m v\u1ec1 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft trong n\u00e3o v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng"},"content":{"rendered":"<p>Nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp h\u1ed3i c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean 141.311 b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft trong n\u00e3o, cho th\u1ea5y nh\u00f3m s\u1eed d\u1ee5ng warfarin ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng kh\u00e1ng vitamin K (NOAC) c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n cao h\u01a1n so v\u1edbi nh\u00f3m kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng tr\u01b0\u1edbc \u0111\u00f3. M\u1eb7c d\u00f9 v\u1eady, vi\u1ec7c s\u1eed d\u1ee5ng NOAC c\u00f3 nguy c\u01a1 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n th\u1ea5p h\u01a1n so v\u1edbi warfarin (hi\u1ec7u s\u1ed1 nguy c\u01a1 hi\u1ec7u ch\u1ec9nh l\u00e0 -5,7%; t\u1ec9 su\u1ea5t ch\u00eanh hi\u1ec7u ch\u1ec9nh l\u00e0 0,75).<\/p>\n<h2>Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c \u0111\u0103ng t\u1ea3i tr\u00ean JAMA ng\u00e0y 25\/01\/2018.<\/h2>\n<p>C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng kh\u00e1ng vitamin K (NOAC) ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong d\u1ef1 ph\u00f2ng b\u1ec7nh l\u00ed huy\u1ebft kh\u1ed1i-t\u1eafc m\u1ea1ch, song d\u1eef li\u1ec7u v\u1ec1 bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft trong n\u00e3o (ICH) do NOAC c\u00f2n r\u1ea5t h\u1ea1n ch\u1ebf.<\/p>\n<p>Ch\u00ednh v\u00ec v\u1eady, c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp h\u1ed3i c\u1ee9u n\u00e0y nh\u1eb1m \u0111\u00e1nh gi\u00e1 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng tr\u01b0\u1edbc \u0111\u00f3 (warfarin, NOAC hay kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng (OAC)) v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n ICH. Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean 141.311 b\u1ec7nh nh\u00e2n ICH v\u00e0o vi\u1ec7n t\u1eeb th\u00e1ng 10\/2013 \u0111\u1ebfn th\u00e1ng 12\/2016 t\u1ea1i 1662 b\u1ec7nh vi\u1ec7n t\u1ea1i Hoa K\u00ec tu\u00e2n th\u1ee7 theo H\u01b0\u1edbng d\u1eabn v\u1ec1 \u0110\u1ed9t qu\u1ecb. Trong \u0111\u00f3, ph\u01a1i nhi\u1ec5m \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng tr\u01b0\u1edbc khi c\u00f3 ICH, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1eed d\u1ee5ng OAC trong v\u00f2ng 7 ng\u00e0y tr\u01b0\u1edbc khi v\u00e0o vi\u1ec7n. Ch\u1ec9 s\u1ed1 \u0111\u1ea7u ra ch\u00ednh l\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n c\u1ee7a m\u1ed7i nh\u00f3m.<\/p>\n<h2>K\u1ebft qu\u1ea3<\/h2>\n<p>K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u cho th\u1ea5y trong s\u1ed1 141.311 b\u1ec7nh nh\u00e2n ICH (tu\u1ed5i trung b\u00ecnh [\u0111\u1ed9 l\u1ec7ch chu\u1ea9n] l\u00e0 68,3 [15,3] n\u0103m; 48,1% l\u00e0 n\u1eef), c\u00f3 15.036 (10,6%) b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng warfarin v\u00e0 4.918 (3,5%) s\u1eed d\u1ee5ng NOAC tr\u01b0\u1edbc khi xu\u1ea5t hi\u1ec7n ICH, v\u1edbi 39.585 (28,0%) v\u00e0 5.783 (4,1%) t\u01b0\u01a1ng \u1ee9ng s\u1eed d\u1ee5ng 1 thu\u1ed1c kh\u00e1ng ti\u1ec3u c\u1ea7u v\u00e0 li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p. C\u00e1c b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng warfarin hay NOAC tr\u01b0\u1edbc \u0111\u00f3 \u0111\u1ec1u l\u1edbn tu\u1ed5i h\u01a1n v\u00e0 c\u00f3 t\u1ea7n su\u1ea5t hi\u1ec7n m\u1eafc rung nh\u0129 v\u00e0 \u0111\u1ed9t qu\u1ecb tr\u01b0\u1edbc \u0111\u00f3 cao h\u01a1n. M\u1ee9c \u0111\u1ed9 \u0111\u1ed9t qu\u1ecb do ICH c\u1ea5p t\u00ednh (l\u01b0\u1ee3ng gi\u00e1 b\u1eb1ng Thang \u0111i\u1ec3m \u0110\u1ed9t qu\u1ecb c\u1ee7a Vi\u1ec7n Y h\u1ecdc qu\u1ed1c gia Hoa K\u00ec) kh\u00f4ng kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea gi\u1eefa 3 nh\u00f3m (trung v\u1ecb l\u00e0 9 [kho\u1ea3ng t\u1ee9 ph\u00e2n v\u1ecb l\u00e0 2-21] \u1edf nh\u00f3m d\u00f9ng warfarin, 8 [2-20] \u1edf nh\u00f3m NOAC, v\u00e0 8 [2-19] \u1edf nh\u00f3m kh\u00f4ng d\u00f9ng OAC). T\u1ec9 l\u1ec7 t\u1eed vong ch\u01b0a hi\u1ec7u ch\u1ec9nh t\u1ea1i b\u1ec7nh vi\u1ec7n l\u1ea7n l\u01b0\u1ee3t l\u00e0 32,6% \u1edf nh\u00f3m warfarin, 26,5% \u1edf nh\u00f3m NOAC, v\u00e0 22,5% \u1edf nh\u00f3m kh\u00f4ng d\u00f9ng OAC. So v\u1edbi nh\u00f3m tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng d\u00f9ng OAC, nguy c\u01a1 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n \u1edf nh\u00f3m d\u00f9ng warfarin tr\u01b0\u1edbc \u0111\u00f3 l\u00e0 cao h\u01a1n (hi\u1ec7u s\u1ed1 nguy c\u01a1 hi\u1ec7u ch\u1ec9nh [ARD] l\u00e0 9% [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 7,9-10,1%]; t\u1ec9 su\u1ea5t ch\u00eanh hi\u1ec7u ch\u1ec9nh [AOR] l\u00e0 1,62 [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 1,53-1,71]) v\u00e0 \u1edf nh\u00f3m d\u00f9ng NOAC tr\u01b0\u1edbc \u0111\u00f3 c\u0169ng cao h\u01a1n (ARD l\u00e0 3,3% [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 1,7%-4,8%]; AOR l\u00e0 1,21 [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 1,11-1,32]). So v\u1edbi nh\u00f3m s\u1eed d\u1ee5ng warfarin tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng NOAC c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n th\u1ea5p h\u01a1n (ARD l\u00e0 \u22125.7% [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 \u22127,3% \u0111\u1ebfn \u22124,2%]; AOR l\u00e0 0.75 [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 0,69-0,81]). Trong nh\u00f3m d\u00f9ng li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p, hi\u1ec7u s\u1ed1 t\u1ec9 l\u1ec7 t\u1eed vong gi\u1eefa nh\u00f3m d\u00f9ng NOAC v\u00e0 d\u00f9ng warfarin v\u1ec1 m\u1eb7t s\u1ed1 h\u1ecdc l\u1ea1i c\u00e0ng l\u1edbn h\u01a1n (32,7% so v\u1edbi 47,1%; ARD l\u00e0 \u221215,0% [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 \u221226,3% \u0111\u1ebfn \u22123,8%]; AOR l\u00e0 0,50 [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 0,29-0,86]) so v\u1edbi trong nh\u00f3m c\u0169ng d\u00f9ng c\u00e1c thu\u1ed1c n\u00f3i tr\u00ean nh\u01b0ng kh\u00f4ng d\u00f9ng li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p (26,4% so v\u1edbi 31,7%; ARD l\u00e0 \u22125,0% [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 \u22126,8% \u0111\u1ebfn \u22123,2%]; AOR l\u00e0 0,77 [kho\u1ea3ng tin c\u1eady 97,5% l\u00e0 0,70-0,85]), tuy nhi\u00ean gi\u00e1 tr\u1ecb P t\u01b0\u01a1ng t\u00e1c l\u00e0 0,07 th\u00ec ch\u01b0a \u0111\u1ee7 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp h\u1ed3i c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean 141.311 b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft trong n\u00e3o, cho th\u1ea5y nh\u00f3m s\u1eed d\u1ee5ng warfarin ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng kh\u00e1ng vitamin K (NOAC) c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n cao h\u01a1n so v\u1edbi nh\u00f3m kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng tr\u01b0\u1edbc [&#8230;]\n","protected":false},"author":1,"featured_media":4154,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4153","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4153","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=4153"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4153\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/4154"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=4153"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=4153"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=4153"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}