Phelan P J, O'Kelly P, Holian J, Walshe J J, Delany C, Slaby J, Winders S, O'Toole D, Magee C, Conlon P J
Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland.
Clin Nephrol. 2011 Mar;75(3):204-11. doi: 10.5414/cn106481.
There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin.
A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed.
The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024).
This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use.
Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
关于血液透析（HD）患者使用华法林的风险，相关数据较少。我们比较了该组患者与未接受华法林治疗的HD患者以及一组接受华法林治疗的非HD患者的严重出血事件。
对141例接受华法林治疗的HD患者（HDW）、704例未接受华法林治疗的HD患者（HDNW）和3266例非透析华法林治疗患者（NDW）进行了回顾性研究。检查了因出血事件和缺血性卒中的住院情况、住院时间和血液制品使用情况。还评估了国际标准化比值（INR）的变异性。
HDW组每100患者年的严重出血发生率为10.8，而HDNW组为8.0（p = 0.593），NDW组为2.1（p < 0.001）。透析患者所需红细胞输注的平均单位数较高，HDW组和HDNW组之间无显著差异。HDW组每100患者年的缺血性卒中风险为1.7，而HDNW组为0.7（p = 0.636），NDW组为0.4（p = 0.003）。与NDW组相比HDW组测量间的INR变异性更高（p = 0.034）。在房颤患者中，HDW组的缺血性卒中发生率高于NDW组（每100患者年2.2次对0.4次事件；p = 0.024）。
本研究证实了HD/终末期肾病（ESRD）相关的较高出血风险，但表明在这些患者中使用华法林可能不会显著增加该风险。我们还证明了尽管使用了华法林，HD患者的缺血性卒中发生率仍较高。
我们的研究比较了接受或未接受华法林治疗的HD患者与接受华法林治疗的非HD患者的严重出血频率以及其次缺血性卒中的频率。主要发现是接受华法林治疗的HD患者的出血频率高于接受华法林治疗的非HD患者，但在接受或未接受华法林治疗的HD患者中无差异。次要发现是接受华法林治疗的HD患者的INR变异性显著高于非HD患者。
