심방세동환자에서 직접 경구용 Xa 저해제 사용으로 인한 주요출혈 발생 위험인자 분석

Abstract

Background : Direct oral anticoagulants (DOACs) are widely used for stroke prevention in patients with non-valvular atrial fibrillation because DOACs have better efficacy and safety profiles than traditional vitamin K antagonists. Despite these advantages, bleeding complications remain a significant concern. This study aimed to comprehensively identify clinical factors associated with major bleeding in Korean patients with atrial fibrilla tion receiving factor Xa inhibitors. Methods : Patients with atrial fibrillation who received factor Xa inhibitors (apixaban, edoxaban, or rivarox aban) between June 2018 and December 2021 at Ewha Womans University Mokdong Hospital and Ewha Womans University Seoul Hospital were retrospectively analyzed. Patients receiving dabigatran, those with less than 3 months of DOAC therapy, and those experiencing thromboembolic events or non-major bleeding were exclud ed. The primary outcome was major bleeding as defined by International Society on Thrombosis and Haemosta sis criteria. Multivariable logistic regression was used to identify independent risk factors. Results : Among 372 patients included in the final analysis, 23 experienced major bleeding events. In multi variable analysis, anemia (adjusted odds ratio (OR): 4.37, 95% confidence interval (CI): 1.81–10.53, p < 0.01) and diuretic use (adjusted OR: 2.57, 95% CI: 1.01–6.17, p < 0.05) were identified as independent risk factors for major bleeding. Conclusion : This study identified anemia and concomitant diuretic use as significant independent risk fac tors for major bleeding in Korean patients receiving factor Xa inhibitors. Findings of this study emphasize the importance of careful monitoring in patients with these risk factors and suggest that clinicians should consider these factors when assessing bleeding risk in patients receiving factor Xa inhibitors.