血液透析患者心房颤动及抗栓治疗的患病率：维也纳血液透析患者心房颤动和血栓栓塞调查（VIVALDI）的横断面结果
Prevalence of Atrial Fibrillation and Antithrombotic Therapy in Hemodialysis Patients: Cross-Sectional Results of the Vienna InVestigation of AtriaL Fibrillation and Thromboembolism in Patients on HemoDIalysis (VIVALDI).
作者信息
Königsbrügge Oliver, Posch Florian, Antlanger Marlies, Kovarik Josef, Klauser-Braun Renate, Kletzmayr Josef, Schmaldienst Sabine, Auinger Martin, Zuntner Günther, Lorenz Matthias, Grilz Ella, Stampfel Gerald, Steiner Stefan, Pabinger Ingrid, Säemann Marcus, Ay Cihan
机构信息
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Department of Medicine, Clinical Division of Oncology, Medical University of Graz, Austria.
出版信息
PLoS One. 2017 Jan 4;12(1):e0169400. doi: 10.1371/journal.pone.0169400. eCollection 2017.
BACKGROUND
Atrial fibrillation (AF) adds significant risk of stroke and thromboembolism in patients on hemodialysis (HD). The aim of this study was to investigate the prevalence of AF in a population-based cohort of HD patients and practice patterns of antithrombotic therapy for stroke prevention in AF.
METHODS
The Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemodialysis (VIVALDI), an ongoing prospective observational cohort study, investigates the prevalence of AF and the risk of thromboembolic events in HD patients in Vienna, Austria. We analyzed cross-sectional data of 626 patients (63.4% men, median age 66 years, approx. 73% of HD patients in Vienna), who provided informed consent. A structured interview with each patient was performed, recent and archived ECGs were viewed and medical histories were verified with electronic records.
RESULTS
The overall prevalence of AF was 26.5% (166 patients, 71.1% men, median age 72 years) of which 57.8% had paroxysmal AF, 3.0% persistent AF, 32.5% permanent AF, and 6.6% of patients had newly diagnosed AF. The median CHA2DS2-VASc Score was 4 [25th-75th percentile 3-5]. In multivariable analysis, AF was independently associated with age (odds ratio: 1.05 per year increase, 95% confidence interval: 1.03-1.07), male sex (1.7, 1.1-2.6), history of venous thromboembolism (2.0, 1.1-3.6), congestive heart failure (1.7, 1.1-2.5), history of or active cancer (1.5, 1.0-2.4) and time on HD (1.08 per year on HD, 1.03-1.13). Antithrombotic treatment was applied in 84.4% of AF patients (anticoagulant agents in 29.5%, antiplatelet agents in 33.7%, and both in 21.1%). In AF patients, vitamin-K-antagonists were used more often than low-molecular-weight heparins (30.1% and 19.9%).
CONCLUSIONS
The prevalence of AF is high amongst HD patients and is associated with age, sex, and distinct comorbidities. Practice patterns of antithrombotic treatment indicate a lack of consensus for stroke prevention in HD patients with AF.
背景
心房颤动（AF）增加了血液透析（HD）患者发生中风和血栓栓塞的重大风险。本研究的目的是调查以人群为基础的HD患者队列中AF的患病率以及预防AF患者中风的抗栓治疗实践模式。
方法
正在进行的前瞻性观察队列研究——维也纳血液透析患者心房颤动和血栓栓塞研究（VIVALDI），调查了奥地利维也纳HD患者中AF的患病率和血栓栓塞事件的风险。我们分析了626例患者（63.4%为男性，中位年龄66岁，约占维也纳HD患者的73%）的横断面数据，这些患者均提供了知情同意。对每位患者进行了结构化访谈，查看了近期和存档的心电图，并通过电子记录核实了病史。
结果
AF的总体患病率为26.5%（166例患者，71.1%为男性，中位年龄72岁），其中57.8%为阵发性AF，3.0%为持续性AF，32.5%为永久性AF，6.6%的患者为新诊断的AF。CHA2DS2-VASc评分中位数为4[第25-75百分位数为3-5]。在多变量分析中，AF与年龄（比值比：每年增加1.05，95%置信区间：1.03-1.07）、男性（1.7，1.1-2.6）、静脉血栓栓塞病史（2.0，1.1-3.6）、充血性心力衰竭（1.7，1.1-2.5）、癌症病史或活动性癌症（1.5，1.0-2.4）以及HD时间（HD每年1.08，1.03-1.13）独立相关。84.4%的AF患者接受了抗栓治疗（29.5%使用抗凝剂，33.7%使用抗血小板药物，21.1%两者都使用）。在AF患者中，维生素K拮抗剂的使用频率高于低分子肝素（30.1%和19.9%）。
结论
HD患者中AF的患病率较高，且与年龄、性别和特定合并症相关。抗栓治疗的实践模式表明，对于HD合并AF患者的中风预防缺乏共识。
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