11. 論文のPICO(主にAbstractから)
P
I
C
O
Patients with atrial fibrillation discharged from hospital after
gastrointestinal bleeding while receiving antithrombotic treatment
Restarted treatment regimens were single or combined
antithrombotic
drugs with oral anticoagulation and antiplatelets.
Risks of all cause mortality, thromboembolism, major bleeding,
and recurrent gastrointestinal bleeding.
Follow-up started 90 days after discharge to avoid confounding
from use of previously prescribed drugs on discharge.
15. 今回の研究手法
デンマークは個人番号が出生時、移民時に付加される。
今回は3つのデータベースをリンクして解析。
Firstly, the Danish national patient registry
1978年以降の入院を全て記録、退院時病名はICDでコード
1996年以降は全ての手術(procedures and surgical operations)を記録
Secondly, the Danish national prescription registry
1995年以降の薬局での処方を記録
Finally, the Danish civil registration system
生死についての情報を記録
16. 今回の研究手法
Selection bias の調整ーStudy populationー
Inclusion criteria
Af患者で抗血栓薬使用中に消化管出血をきたした全ての患者患者
(while receiving single or combined antithrombotic treatment with a vitamin K
antagonist, dabigatran, rivaroxaban, aspirin, clopidogrel, prasugrel, or ticagrelor)
Exclusion criteria
30歳未満、100歳越え
弁膜症患者
人工股関節/膝関節置換後 8週以内の人
深部血栓塞栓症/肺塞栓後 半年以内の人
全国民データを用いていて、Selection biasは低い?
17. 今回の研究手法
Information biasの調整ーStudy populationー
Firstly, the Danish national patient registry
1978年以降の入院を全て記録、退院時病名はICDでコード
このデータベースの信頼性についてもMethodsで記載
In registries, the positive predictive value of
bleeding related hospital admission is
between 89% and 99%.
The agreement with regard to specific bleeding
site suggests that misclassification is rare.
24. 今回の暴露因子
1. Single treatment with oral anticoagulation (vitamin K antagonist, dabigatran, or
rivaroxaban),
2. Single treatment with an antiplatelet agent (aspirin or an adenosine
diphosphate receptor antagonist (clopidogrel, prasugrel, or ticagrelor)),
3. Dual or triple treatment with oral anticoagulation, aspirin, and an adenosine
diphosphate receptor antagonist