Tanaka Marenao, Moniwa Norihito, Ohnishi Hirofumi, Yamashita Tomohisa, Koyama Masayuki, Gocho Yufu, Nishizawa Keitaro, Kimura Yukishige, Sugawara Hirohito, Murakami Sayaka, Okazaki Yusuke, Furuhashi Masato, Yoshida Hideaki, Miura Tetsuji
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan.
Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
Kidney Blood Press Res. 2017;42(3):553-564. doi: 10.1159/000480487. Epub 2017 Sep 18.
BACKGROUND/AIMS: Relationships between the number of anti-thrombosis agents, clinical benefits and adverse events in hemodialysis (HD) patients are unclear.
All patients on HD in 22 institutes (n = 1,071) were enrolled and followed up for 3 years. After exclusion of patients with missing data, kidney transplantation or retraction of consent during the follow-up period (n = 204), mortality rate and ischemic and hemorrhagic events were compared between different regimens of anti-thrombosis agents.
The use of dual or triple antiplatelet (AP) agents (HR:2.03, 95% CI:1.01-4.13, p = 0.04) and the combination of an AP agent and warfarin (WF) (HR:4.84, 95%CI 1.96-11.96, p < 0.001) were associated with an increase in hemorrhagic events compared with no use of anti-thrombosis agents. No anti-thrombosis regimen was associated with a significant change in risk of ischemic stroke. The use of dual or triple AP agents, but not WF, was associated with an increase in cardiovascular mortality (HR:2.48, 95% CI:1.24-4.76, p = 0.01).
A significant increase in hemorrhagic events by the use of dual or more AP agents and by co-administration of an AP agent and WF in patients on HD should be considered in planning their anti-thrombosis regimen.
背景/目的：血液透析（HD）患者中抗血栓药物的数量、临床益处和不良事件之间的关系尚不清楚。
纳入22家机构中所有接受HD治疗的患者（n = 1071），并进行3年随访。在排除随访期间数据缺失、接受肾移植或撤回同意书的患者（n = 204）后，比较不同抗血栓药物治疗方案之间的死亡率、缺血性和出血性事件。
与未使用抗血栓药物相比，使用双联或三联抗血小板（AP）药物（HR：2.03，95%CI：1.01 - 4.13，p = 0.04）以及AP药物与华法林（WF）联合使用（HR：4.84，95%CI 1.96 - 11.96，p < 0.001）与出血事件增加相关。没有抗血栓治疗方案与缺血性卒中风险的显著变化相关。使用双联或三联AP药物而非WF与心血管死亡率增加相关（HR：2.48，95%CI：1.24 - 4.76，p = 0.01）。
在规划HD患者的抗血栓治疗方案时，应考虑到使用双联或更多AP药物以及AP药物与WF联合使用会使出血事件显著增加。
