Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Nephrol Dial Transplant. 2018 Jan 1;33(1):170-176. doi: 10.1093/ndt/gfx199.
The risk-benefit ratio of vitamin K antagonists for different CHA2DS2-VASc scores in patients with end-stage renal disease treated with dialysis is unknown. The aim of this study was to investigate the association between vitamin K antagonist use and mortality for different CHA2DS2-VASc scores in a cohort of end-stage renal disease patients receiving dialysis treatment.
We prospectively followed 1718 incident dialysis patients. Hazard ratios were calculated for all-cause and cause-specific (stroke, bleeding, cardiovascular and other) mortality associated with vitamin K antagonist use.
Vitamin K antagonist use as compared with no vitamin K antagonist use was associated with a 1.2-fold [95% confidence interval (95% CI) 1.0-1.5] increased all-cause mortality risk, a 1.5-fold (95% CI 0.6-4.0) increased stroke mortality risk, a 1.3-fold (95% CI 0.4-4.2) increased bleeding mortality risk, a 1.2-fold (95% CI 0.9-1.8) increased cardiovascular mortality risk and a 1.2-fold (95% CI 0.8-1.6) increased other mortality risk after adjustment. Within patients with a CHA2DS2-VASc score ≤1, vitamin K antagonist use was associated with a 2.8-fold (95% CI 1.0-7.8) increased all-cause mortality risk as compared with no vitamin K antagonist use, while vitamin K antagonist use within patients with a CHA2DS2-VASc score ≥2 was not associated with an increased mortality risk after adjustment.
Vitamin K antagonist use was not associated with a protective effect on mortality in the different CHA2DS2-VASc scores in dialysis patients. The lack of knowledge on the indication for vitamin K antagonist use could lead to confounding by indication.
对于接受透析治疗的终末期肾病患者，不同 CHA2DS2-VASc 评分的维生素 K 拮抗剂的风险效益比尚不清楚。本研究旨在调查透析治疗的终末期肾病患者队列中，不同 CHA2DS2-VASc 评分的维生素 K 拮抗剂使用与死亡率之间的关联。
我们前瞻性随访了 1718 例新发生的透析患者。计算了所有原因和特定原因（中风、出血、心血管和其他）死亡率与维生素 K 拮抗剂使用相关的风险比。
与未使用维生素 K 拮抗剂相比，使用维生素 K 拮抗剂与全因死亡率风险增加 1.2 倍（95%置信区间 [95%CI]，1.0-1.5）、中风死亡率风险增加 1.5 倍（95%CI，0.6-4.0）、出血死亡率风险增加 1.3 倍（95%CI，0.4-4.2）、心血管死亡率风险增加 1.2 倍（95%CI，0.9-1.8）和其他死亡率风险增加 1.2 倍（95%CI，0.8-1.6），经调整后。在 CHA2DS2-VASc 评分≤1 的患者中，与未使用维生素 K 拮抗剂相比，使用维生素 K 拮抗剂与全因死亡率风险增加 2.8 倍（95%CI，1.0-7.8）相关，而在 CHA2DS2-VASc 评分≥2 的患者中，经调整后，使用维生素 K 拮抗剂与死亡率风险增加无关。
在不同的 CHA2DS2-VASc 评分的透析患者中，维生素 K 拮抗剂的使用与死亡率没有保护作用。对维生素 K 拮抗剂使用指征的认识不足可能导致指示性偏倚。
