Hirai Toshinori, Hamada Yukihiro, Geka Yujiro, Kuwana Shiori, Hirai Koji, Ishibashi Mai, Fukaya Yutaka, Kimura Toshimi
Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-866, Japan.
Eur J Clin Pharmacol. 2017 Nov;73(11):1491-1497. doi: 10.1007/s00228-017-2316-1. Epub 2017 Aug 9.
The anticoagulant effect of warfarin used to treat stroke has been shown to vary with the concomitant use of medications and comorbidity. Concomitant use of antithrombotic drugs and underlying chronic kidney disease (CKD) represent risk factors for bleeding events. We conducted a comprehensive investigation of the background characteristics and concomitant use of drugs to identify the risk factors for warfarin-related bleeding, focusing on renal function.
The study population consisted of patients prescribed warfarin at the Tokyo Women's Medical University Hospital. A retrospective review of the patient data, including bleeding events, bleeding sites, the patient's background, concomitant use of drugs, and laboratory data was carried out, and the incidence of bleeding events was compared in patient groups stratified according to CKD stage and antithrombotic drug use. Multivariate logistic regression analysis was performed to determine the risk factors for warfarin-related bleeding.
Of the 3,831 patients included in the study, the incidence of warfarin-related bleeding was 3.0 events per 100 patient-years. The multivariate logistic regression analysis identified age > 65 years, body mass index (BMI), alanine aminotransferase (ALT), estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m, prothrombin time-international normalized ratio (PT-INR), and concomitant use of antithrombotic drugs as risk factors for warfarin-related bleeding.
The present analyses identified age > 65 years, BMI, ALT, eGFR <30 mL/min/1.73 m, PT-INR, and concomitant use of antithrombotic drugs as independent risk factors for warfarin-related bleeding. We should pay attention to the risk factors associated with warfarin-related bleeding when prescribing warfarin in patients with renal impairment.
已表明用于治疗中风的华法林的抗凝效果会因同时使用的药物和合并症而有所不同。同时使用抗血栓药物和潜在的慢性肾脏病（CKD）是出血事件的危险因素。我们对背景特征和药物的同时使用情况进行了全面调查，以确定与华法林相关出血的危险因素，重点关注肾功能。
研究人群包括东京女子医科大学医院开具华法林处方的患者。对患者数据进行回顾性分析，包括出血事件、出血部位、患者背景、同时使用的药物和实验室数据，并比较根据CKD分期和抗血栓药物使用情况分层的患者组中出血事件的发生率。进行多因素逻辑回归分析以确定与华法林相关出血的危险因素。
在纳入研究的3831例患者中，华法林相关出血的发生率为每100患者年3.0次事件。多因素逻辑回归分析确定年龄>65岁、体重指数（BMI）、丙氨酸氨基转移酶（ALT）、估计肾小球滤过率（eGFR）<30 mL/min/1.73 m²、凝血酶原时间国际标准化比值（PT-INR）以及同时使用抗血栓药物是与华法林相关出血的危险因素。
本分析确定年龄>65岁、BMI、ALT、eGFR<30 mL/min/1.73 m²、PT-INR以及同时使用抗血栓药物是与华法林相关出血的独立危险因素。在为肾功能损害患者开具华法林处方时，我们应注意与华法林相关出血相关的危险因素。
