Tramadol and the risk of adverse cardiovascular events for patients with non-cancer pain
Notice bibliographique
Résumé
Tramadol and codeine are both weak opioids indicated for the treatment of acute and chronic moderate to moderately severe pain, though their pharmacologic profiles differ substantially. Due to the perceived low risk of abuse of tramadol compared to other opioid, prescriptions for tramadol have increased by 30% in Canada and 65% in the United States over the last decade. Aside from acting on the mu-opioid receptor, tramadol also exerts its analgesic activity through inhibiting the reuptake of serotonin and norepinephrine in the central nervous system. Excess amounts of both neurotransmitters can have pro-arrhythmic effects and can stimulate the sympathetic nervous system, resulting in vasoconstriction and blood pressure elevation. It can also cause platelet aggregation and coagulation. These physiological adverse effects, which have been demonstrated in animal and human models, could potentially result in increased risks of myocardial infarction, ischemic stroke, and arrhythmia. Evidence on the effect of tramadol and cardiovascular safety is limited and requires further investigation. In this thesis, I conducted a retrospective, population-based cohort study to examine the rates of myocardial infarction, unstable angina, coronary revascularization, ischemic stroke, cardiovascular death, and all-cause mortality with the use of tramadol compared to those with the use of codeine among patients with non-cancer pain. Using data from the United Kingdom's Clinical Practice Research Datalink (CPRD), linked to hospitalization and vital statistics data, I identified new users of tramadol or codeine who were 18 years or older with at least one year of enrolment in the CPRD database prior to cohort entry. Cohort entry was defined by the date of new prescription of either tramadol or codeine, with exposure defined using an approach analogous to an intention-to-treat. Hazard ratio (HR) and corresponding 95% confidence interval (CI) were estimated using Cox Proportional hazards models, adjusted for high-dimensional propensity score to minimize potential confounding. Our final cohort included 1,037,727 new users (123,394 tramadol and 914,333 codeine) from April 1st, 1998 to March 31st, 2017. Most baseline characteristics were similar between the tramadol and codeine groups (standardized differences < 0.1). The mean age at cohort entry was 54.4+/-17.7 years for the tramadol group and 52.4+/-19.0 years for the codeine group. Compared with the use of codeine, the use of tramadol was not associated with an increased risk of myocardial infarction (adjusted HR: 1.003, 95% CI: 0.81, 1.24). There was also no evidence of increased risk of the secondary outcomes of unstable angina, ischemic stroke, coronary revascularization, cardiovascular death, and all-cause mortality. The use of tramadol was not found to increase risk of myocardial infarction and other atherosclerotic events compared with the use of codeine. Nonetheless, prescriptions for both medications should be used judiciously based on the risks and benefits of current treatment in the presence of the ongoing opioid epidemic. Future studies are required to further investigate the association of arrhythmia and sudden cardiac death due to tramadol's effect on the QT interval and its propensity for serotonin syndrome.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».