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J Am Heart Assoc:房颤后华法林抗凝:肾功能不全是否影响结局?

2017-04-28 常路 环球医学

肾功能不全是否会为华法林治疗的房颤患者带来较差的抗凝控制?是否影响相关结局?2017年3月,发表在《J Am Heart Assoc.》的一项研究调查了新诊断为房颤的肾功能不全患者初始华法林后治疗窗内时间和结局。



肾功能不全是否会为华法林治疗的房颤患者带来较差的抗凝控制?是否影响相关结局?2017年3月,发表在《J Am Heart Assoc.》的一项研究调查了新诊断房颤的肾功能不全患者初始华法林后治疗窗内时间和结局。

背景:肾功能不全是否会为华法林治疗的房颤患者带来较差的抗凝控制,以及较差的抗凝控制是否与这些患者不良结局风险相关,是未知的。

方法和结果:这是一项在斯德哥尔摩肌酐测量(SCREAM)队列中进行的观察性研究,队列纳入了2006~2011年瑞典斯德哥尔摩所有新诊断为房颤且初始华法林治疗的患者(7738人)。根据血清肌酐计算估计肾小球滤过率(eGFR,mL/min/1.73m2)。治疗窗内时间(TTR)依据开始用药到华法林停药、不良事件或随访末期(2年)时的国际标准化比率(INR)测量中评估。不良事件为颅内出血、缺血性卒中心肌梗死或死亡的复合。中位254天期间,基于每位患者中位21个INR测量,TTR为83%。eGFR<30的患者中,TTR为70%,比正常肾功能的患者约低10%。观察期间,不良事件发生率为4.0%,TTR≤75%的患者处于较高的不良事件风险。这独立于患者特征、合并症、INR检查次数、华法林暴露天数,值得注意的是,也独立于eGFR:TTR为75%~60%的调整比值比为1.84(95% CI,1.41~2.40),TTR<60%为2.09(95% CI,1.59~2.74)。eGFR和TTR与不良事件间不相互作用(P=0.2)。

结论:严重慢性肾病(eGFR<30)的房颤患者华法林治疗时具有较差的INR控制。最佳的TTR(>75%)与较低的不良事件风险相关,且独立于潜在的肾功能。

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    2017-05-20 yese
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    2017-05-10 cuiyejia

    学习了,谢谢

    0

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    2017-05-04 清幽蓝燕yan

    文章很好,感谢作者分享

    0

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    2017-04-30 zhaojie88
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    2017-04-30 slcumt
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    2017-04-29 jin321

    学习

    0

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    2017-04-29 圣艮山

    学习了不少事

    0

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