Hasegawa Hajime
Department of Nephrology and Hypertension, and Blood Purification Center, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Ann Vasc Dis. 2017 Sep 25;10(3):170-7. doi: 10.3400/avd.ra.17-00062.
Recent years, multiple studies regarding clinical efficacy and risks of Warfarin therapy in dialysis patients have been reported, and not a few reports conclude that clinical advantage of Warfarin is questionable in dialysis patients. Conversely, its hemorrhagic risk might be a little more serious in dialysis patients comparing to non-dialysis patients. Basically, it is assumed that long-term administration of Warfarin accelerates the development of vascular athelosclerosis because of the abolished anti-calcification effect of Gla-protein activation by decreased vitamin K activity. This assumption is recently confirmed by multiple reports, suggesting that the Warfarin administration might be worse harmful than ever expected in dialysis patients who are essentially considered to have higher risk of calcification comparing to non-dialysis patients. In addition, it is recently well considered that the Warfarin administration would be a risk factor to cause Warfarin skin necrosis or calciphylaxis, therapy resistant ulcerative skin lesions, which are considered to be highly related to the Warfarin-induced transient hypercoagulable state or acceleration of calcification. Therefore, it is considered that the indication of Warfarin administration to dialysis patients should be carefully assessed. (This is a translation of Jpn J Vasc Surg 2017; 26: 83-90.).
近年来，已有多项关于华法林治疗透析患者的临床疗效和风险的研究报道，不少报告得出结论，华法林在透析患者中的临床优势值得怀疑。相反，与非透析患者相比，其出血风险在透析患者中可能更严重一些。基本上，人们认为长期服用华法林会加速血管动脉粥样硬化的发展，因为维生素K活性降低会消除γ-羧基谷氨酸蛋白激活的抗钙化作用。这一假设最近得到了多项报告的证实，表明在本质上被认为比非透析患者有更高钙化风险的透析患者中，服用华法林可能比预期的危害更大。此外，最近人们普遍认为，服用华法林会成为导致华法林皮肤坏死或钙化防御（一种治疗抵抗性溃疡性皮肤病变）的危险因素，这被认为与华法林引起的短暂高凝状态或钙化加速高度相关。因此，认为应仔细评估对透析患者使用华法林的适应症。（这是对《日本血管外科学杂志》2017年；26：83 - 90的翻译。）
