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Am J Kidney Dis:房颤和肾功能降低患者华法林使用的有效性和安全性评估

2016-12-25 haofan MedSci原创

在老年房颤患者中,开始华法林治疗与各个肾功能分层的1年复合结局风险显著降低有关。华法林使用相关的大出血风险只那些eGFR在60-89 mL/min/1.73 m2的患者中有所增加。

房颤和肾功能降低患者华法林使用的有效性和安全性并不确定。近日,肾脏病领域权威杂志Am J Kidney Dis上发表了一篇研究文章,研究人员旨在对房颤和肾功能降低患者使用华法林的有效性和安全性进行评估。

该研究为以社区为基础的回顾性队列研究(2003年5月1日至2012年3月31日),分析加拿大阿尔伯塔省范围内的实验室和管理数据。研究者纳入了14,892名66岁以上的成年新发房颤患者,并对其肾功能进行测量,长期透析患者或肾移植接受者均予以排除。倾向性评分被用来构建一个匹配的队列,这些队列为房颤诊断60天内有无服用华法林治疗的房颤患者。

该研究的主要结局事件为开始华法林治疗1年之内(为服用华法林的参与者为匹配日期):(1)复合全因死亡、缺血性卒中或短暂性脑缺血发作(也作为独立的终点进行评估)和(2)因大出血首次住院或急诊就诊,大出血定义为颅内、上或下消化道或其他部位大出血。

该研究的测量指标包括使用CKD-EPI肌酐方程估计的基线水平肾小球滤过率(GFR)。患者在估计肾小球滤过率(eGFR)分类范围内进行匹配,其分类为:≥90、60-89、45-59、30-44,和<30 mL/min/1.73 m2。收集基线特征信息(社会人口统计信息、并存的疾病和处方药物的使用)。

在所有eGFR分类中,相比于未服用华法林的参与者,开始华法林治疗与低风险的复合结局相关(对于eGFR≥90、60-89、45-59、30-44,和<30 mL/min/1.73 m2分类调整后的风险比[95%可信区间为]分别为:0.59 [0.35-1.01 ]、0.61 [0.54-0.70]、0.55 [0.47-0.65]、0.54 [0.44-0.67]和0.64 [0.47-0.87] mL/min/1.73 m2)。相对于未服用华法林治疗的参与者,华法林治疗与大出血风险较高无关,除了那些eGFR在60-89 mL/min/1.73 m2的患者(风险比为1.36;95%可信区间为1.13-1.64)。

由此可见,在老年房颤患者中,开始华法林治疗与各个肾功能分层的1年复合结局风险显著降低有关。华法林使用相关的大出血风险只那些eGFR在60-89mL/min/1.73 m2的患者中有所增加。

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    2016-12-27 gwc389

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