심방세동과 말기 콩팥병이 동반된 환자에서 와파린과 항혈소판 요법의 안전성과 효과 비교
Comparison of the Efficacy and Safety of Warfarin and Antiplatelet Therapy in Patients with Atrial Fibrillation and End-Stage Renal Disease
3
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: The optimal strategy for anticoagulation treatment in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has not been established. We evaluated the efficacy and bleeding risk of warfarin and antiplatelet agents in patients with AF and ESRD. Methods: We retrospectively reviewed the medical records of 256 patients with AF and ESRD and included 158 patients (age, 63.7 ± 12.2 years; male sex, n = 103) with a CHA2DS2-VASc score ≥ 1 who were taking warfarin (n = 53) or an antiplatelet agent (n = 105). Results: During the follow-up period (31.0 ± 29.4 months), 10 ischemic events and 29 major bleeding events occurred. The thromboembolic event rate did not significantly differ between the warfarin and antiplatelet groups (1.9% and 8.6%, respectively; p = 0.166). However, the rate of major bleeding events was significantly higher in the warfarin group than it was in the antiplatelet group (32.1% and 11.4%, respectively; p = 0.002). Cox’s regression analysis indicated that warfarin was related to an increased risk of major bleeding events (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.60-7.36; p = 0.001). Conversely, warfarin was not related to a decreased risk of thromboembolic events (HR, 0.34; 95% CI, 0.04-2.70; p = 0.306). Conclusions: In patients with AF and ESRD, warfarin use was associated with an increased risk of bleeding events, compared with antiplatelet agents.
Abstract
Background/Aims: The optimal strategy for anticoagulation treatment in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has not been established. We evaluated the efficacy and bleeding risk of warfarin and antiplatelet agents in patients with AF and ESRD. Methods: We retrospectively reviewed the medical records of 256 patients with AF and ESRD and included 158 patients (age, 63.7 ± 12.2 years; male sex, n = 103) with a CHA2DS2-VASc score ≥ 1 who were taking warfarin (n = 53) or an antiplatelet agent (n = 105). Results: During the follow-up period (31.0 ± 29.4 months), 10 ischemic events and 29 major bleeding events occurred. The thromboembolic event rate did not significantly differ between the warfarin and antiplatelet groups (1.9% and 8.6%, respectively; p = 0.166). However, the rate of major bleeding events was significantly higher in the warfarin group than it was in the antiplatelet group (32.1% and 11.4%, respectively; p = 0.002). Cox’s regression analysis indicated that warfarin was related to an increased risk of major bleeding events (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.60-7.36; p = 0.001). Conversely, warfarin was not related to a decreased risk of thromboembolic events (HR, 0.34; 95% CI, 0.04-2.70; p = 0.306). Conclusions: In patients with AF and ESRD, warfarin use was associated with an increased risk of bleeding events, compared with antiplatelet agents.
참고문헌 (25)
- Hart RG, "Atrial fibrillation and thromboembolism : a decade of progress in stroke prevention", Ann Intern Med, 131, pp.688~695 (1999)
- Wolf PA, "Atrial fibrillation as an independent risk factor for stroke : the Framingham study", Stroke, 22, pp.983~988 (1991)
- Das M, "Increased prevalence of coronary artery disease, silent myocardial ischemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, mitral annular calcium, and aortic valve calcium in patients with chronic renal insufficiency", Cardiol Rev, 14, pp.14~17 (2006)
- Olesen JB, "Stroke and bleeding in atrial fibrillation with chronic kidney disease", N Engl J Med, 367, pp.625~635 (2012)
- Reinecke H, "Dilemmas in the management of atrial fibrillation in chronic kidney disease", J Am Soc Nephrol, 20, pp.705~711 (2009)
- Mega JL, "A new era for anticoagulation in atrial fibrillation", N Engl J Med, 365, pp.1052~1054 (2011)
- Carrero JJ, "Warfarin, kidney dysfunction, and outcomes following acute myocardial infarction in patients with atrial fibrillation", JAMA, 311, pp.919~928 (2014)
- Chen JJ, "Anti-platelet or anti-coagulant agent for the prevention of ischemic stroke in patients with end-stage renal disease and atrial fibrillation-A nation-wide database analyses", Int J Cardiol, 177, pp.1008~1011 (2014)
- Shah M, "Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis", Circulation, 129, pp.1196~1203 (2014)
- Wizemann V, "Atrial fibrillation in hemodialysis patients : clinical features and associations with anticoagulant therapy", Kidney Int, 77, pp.1098~1106 (2010)
- Lip GY, "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach : the Euro heart survey on atrial fibrillation", Chest, 137, pp.263~272 (2010)
- Pisters R, "A novel user-friendly score(HAS-BLED)to assess 1-year risk of major bleeding in patients with atrial fibrillation : the Euro heart survey", Chest, 138, pp.1093~1100 (2010)
- Rosendaal FR, "A method to determine the optimal intensity of oral anticoagulant therapy", Thromb Haemost, 69, pp.236~239 (1993)
- January CT, "2014 AHA", ACC, American Heart Association task force on practice guidelines and the Heart Rhythm Society, pp.Circulation, 2014[DOI]
- Herzog CA, "Cardiovascular disease in chronic kidney disease. A clinical update from kidney disease: improving global outcomes (KDIGO)", Kidney Int, 80, pp.572~586 (2011)
- Verma A, "2014 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation", Can J Cardiol, 30, pp.1114~1130 (2014)
- Tomura S, "Fibrinogen, coagulation factor VII, tissue plasminogen activator, plasminogen activator inhibitor-1, and lipid as cardiovascular risk factors in chronic hemodialysis and continuous ambulatory peritoneal dialysis patients", Am J Kidney Dis, 27, pp.848~854 (1996)
- Marinigh R, "Severe renal impairment and stroke prevention in atrial fibrillation : implications for thromboprophylaxis and bleeding risk", J Am Coll Cardiol, 57, pp.1339~1348 (2011)
- Thet Z, "Atrial fibrillation and warfarin use in haemodialysis patients: an individualized holistic approach is important in stroke prevention", Nephrology(Carlton), 18, pp.331~339 (2013)
- Limdi NA, "Warfarin dosing in patients with impaired kidney function", Am J Kidney Dis, 56, pp.823~831 (2010)
- Limdi NA, "Kidney function influences warfarin responsiveness and hemorrhagic complications", J Am Soc Nephrol, 20, pp.912~921 (2009)
- Friberg L, "Stroke in paroxysmal atrial fibrillation : report from the Stockholm Cohort of Atrial Fibrillation", Eur Heart J, 31, pp.967~975 (2010)
- Hsu JC, "Differences in anticoagulant therapy prescription in patients with paroxysmal versus persistent atrial fibrillation", Am J Med, 128, pp.e1~e654 (2015)
- Fauchier L, "Causes of death and influencing factors in patients with atrial fibrillation", Am J Med, 129, pp.1278~1287 (2016)
- "Kidney disease statistics for the United States" (2018)[URL]