Yodogawa Kenji, Mii Akiko, Fukui Megumi, Iwasaki Yu-Ki, Hayashi Meiso, Kaneko Tomohiro, Miyauchi Yasushi, Tsuruoka Shuichi, Shimizu Wataru
Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Divisions of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Heart Vessels. 2016 Oct;31(10):1676-80. doi: 10.1007/s00380-015-0777-7. Epub 2015 Dec 8.
Atrial fibrillation (AF) is one of the major risk factor for ischemic stroke, and oral anticoagulation is generally indicated for prevention of stroke. However, the utility of oral anticoagulation for AF in dialysis patients remains controversial. In this single-center, retrospective, observational study, data from 1120 patients on maintenance hemodialysis were analyzed. Baseline medical data were collected from dialysis records including age, gender, the cause of end-stage renal disease, dialysis vintage, and comorbidities. We evaluated outcomes including stroke, major hemorrhage, and death. A total of 106 (11.4 %) patients had AF. After exclusion criteria were applied, 84 patients had analyzable data. Warfarin was prescribed in 30 (35.7 %) of these patients. The remaining 54 patients were classified as the non-warfarin group. CHADS2 score was not significantly different between the warfarin and non-warfarin group. During the mean 47 months of follow up, 7 strokes occurred. However, warfarin use was not associated with the risk for stroke [hazard ratio (HR) 1.07; 95 % confidence interval (CI) 0.20-5.74]. Kaplan-Meier analysis showed no statistically significant difference in the overall survival, stroke-free survival or bleeding-free survival between the warfarin and non-warfarin group. AF is common in Japanese dialysis patients. Despite a certain prevalence of oral anticoagulation, the present study demonstrated neither beneficial nor detrimental effects. A large randomized controlled trial should be considered.
心房颤动（AF）是缺血性卒中的主要危险因素之一，口服抗凝治疗通常用于预防卒中。然而，口服抗凝治疗在透析患者房颤中的应用仍存在争议。在这项单中心、回顾性、观察性研究中，分析了1120例维持性血液透析患者的数据。从透析记录中收集基线医疗数据，包括年龄、性别、终末期肾病病因、透析时间和合并症。我们评估了包括卒中、大出血和死亡在内的结局。共有106例（11.4%）患者患有房颤。应用排除标准后，84例患者有可分析的数据。其中30例（35.7%）患者使用了华法林。其余54例患者被归为非华法林组。华法林组和非华法林组的CHADS2评分无显著差异。在平均47个月的随访期间，发生了7例卒中。然而，使用华法林与卒中风险无关[风险比（HR）1.07；95%置信区间（CI）0.20 - 5.74]。Kaplan-Meier分析显示，华法林组和非华法林组在总生存率、无卒中生存率或无出血生存率方面无统计学显著差异。房颤在日本透析患者中很常见。尽管口服抗凝治疗有一定的普及率，但本研究表明其既无有益作用也无有害作用。应考虑进行一项大型随机对照试验。
