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Thromb Haemost:华法林治疗肾功能降低的房颤患者为何结局不佳?

2018-01-22 王淳 环球医学资讯

2017年12月,发表在《Thromb Haemost》的一项由丹麦和英国科学家进行的回顾性分析,考察了华法林治疗房颤患者的肾功能、治疗时间范围和结局。

2017年12月,发表在《Thromb Haemost》的一项由丹麦和英国科学家进行的回顾性分析,考察了华法林治疗房颤患者的肾功能、治疗时间范围和结局。

房颤口服抗凝药的随机对照试验中排除肾功能严重降低的患者。在这个人群中华法林治疗是矛盾的,有关抗凝药对照和对不良结局影响的数据是必要的。通过全国注册库中个体水平链接,研究人员识别出1997~2011年间从丹麦医院出院的所有房颤患者。根据估算肾小球滤过率(eGFR)对可获得血清肌酐检测的患者进行分类。采用Rosendaal法计算治疗窗内时间(TTR)。采用多变量Cox回归分析及eGFR估算卒中和出血风险,并在随访期内单独用TTR估算时间。用可用的国际标准化比和肌氨酸测试识别出10423名华法林治疗的房颤患者;5527名eGFR>60 mL/min/1.73 m2,4524名eGFR 30~60 mL/min/1.73 m2,372名eGFR<30 mL/min/1.73 m2。在eGFR?>?60、30~59和<30 mL/min/1.73 m2的患者中,中位TTR分别是66.7%、61.2%和49.7%。在eGFR30~59的患者中,TTR<70%与较高的卒中/血栓栓塞(风险比[HR]:1.39;95%置信区间[CI]:1.20~1.60)和出血(HR:1.22;95%CI:1.05~1.42)相关。在eGFR<30 mL/min/1.73 m2的患者中,存在较高的卒中/血栓栓塞(HR:1.24;95% CI:0.86~1.80)和出血(HR:1.17;95% CI:0.83~1.65)风险趋势。总体上,华法林治疗的肾功能降低的房颤患者抗凝治疗控制不佳,这可能与不良结局的风险相关。

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    2018-05-17 changfy
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    2018-12-27 yese
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    2018-02-24 秀红

    学习了

    0

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