Çanga Yiğit, Güvenç Tolga Sinan, Çalık Ali Nazmi, Karataş Mehmet Baran, Akdeniz Evliya, Yüksel Gizem, Emre Ayşe
Division of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tıbbiye Street No:13, Kadıköy, Istanbul, Turkey.
Wien Klin Wochenschr. 2018 Jul;130(13-14):436-445. doi: 10.1007/s00508-018-1350-z. Epub 2018 Jun 4.
Warfarin-related nephropathy (WRN) is a complication of warfarin over-anticoagulation that is associated with acute and/or chronic renal dysfunction and increased mortality. The long-term effects of warfarin on renal function has not been adequately studied in patients with a mechanical prosthetic valve (MPV).
To study the time-dependent effects of over-anticoagulation on renal function in patients with a MPV.
A total of 193 patients who underwent MPV implantation and were followed up in this study were eligible for inclusion. Time above therapeutic international normalized ratio (INR) range (TATR) was calculated by dividing the number of INR measurements above target in a year by the total number of INR measurements within a year. Patients were divided into quartiles according to average TATR at 60 months.
At 60 months more patients within the 4th quartile had a ≥20% reduction in the estimated glomerular filtration rate (eGFR, 25.0%, p = 0.04) and chronic kidney disease (CKD, 33.0%, p = 0.07) compared to patients within the 1st quartile. High TATR remained a significant determinant for reduction in eGFR (odds ratio OR: 7.50, 95% confidence interval CI:1.55-36.32) and CKD (OR:5.15, 95% CI: 1.26-20.62) after adjusting for other variables. Longitudinal analysis revealed that the change in eGFR was related to the duration of warfarin use (p < 0.001) and the interaction between the duration of warfarin use and TATR (p = 0.03). Similar findings were observed in patients without CKD at baseline, but not in those with CKD before the index operation.
Anticoagulation over targeted INR values is associated with a steeper decline in eGFR and an increased frequency of CKD in patients with a MPV.
华法林相关肾病（WRN）是华法林抗凝过度的一种并发症，与急性和/或慢性肾功能不全及死亡率增加相关。华法林对机械瓣膜置换术（MPV）患者肾功能的长期影响尚未得到充分研究。
研究抗凝过度对MPV患者肾功能的时间依赖性影响。
本研究共纳入193例行MPV植入术并接受随访的患者。治疗国际标准化比值（INR）范围之上的时间（TATR）通过将一年内高于目标值的INR测量次数除以一年内INR测量的总次数来计算。根据60个月时的平均TATR将患者分为四分位数。
在60个月时，与第一四分位数的患者相比，第四四分位数的患者中更多患者的估计肾小球滤过率（eGFR）降低≥20%（25.0%，p = 0.04）以及患有慢性肾脏病（CKD，33.0%，p = 0.07）。在调整其他变量后，高TATR仍然是eGFR降低（比值比OR：7.50，95%置信区间CI：1.55 - 36.32）和CKD（OR：5.15，95%CI：1.26 - 20.62）的重要决定因素。纵向分析显示，eGFR的变化与华法林使用时长相关（p < 0.001）以及华法林使用时长与TATR之间的相互作用相关（p = 0.03）。在基线时无CKD的患者中观察到类似结果，但在首次手术前患有CKD的患者中未观察到。
对于MPV患者，抗凝超过目标INR值与eGFR更急剧下降及CKD发生率增加相关。
