Marcus Laura, Mackeigan Linda, Leblanc Kori, Orlov David, Mitsakakis Nicholas, Austin Zubin, Jassal Sarbjit Vanita, Battistella Marisa
Clin Nephrol. 2019 Nov;92(5):226-232. doi: 10.5414/CN109724.
Antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is considered a standard of care, but for hemodialysis (HD) patients the benefits are unclear, and bleeding risks are high. Our study objective was to compare cardiologists' and nephrologists' stroke prevention practices in different patient risk scenarios.
A cross-sectional, online survey was distributed to members of three Canadian physician societies (Nephrology, Cardiovascular, Heart Rhythm), and to cardiologists affiliated with three Canadian Universities. The questionnaire included four AF scenarios in HD patients with varying stroke and bleeding risks. Physicians selected one of six antithrombotic therapy options for each scenario.
Cardiologists were 3 times more likely than nephro-logists to choose anticoagulant therapy over both antiplatelet and no drug therapy, regardless of stroke or bleeding risk (p < 0.001). Physicians' drug therapy choices in regards to level of stroke and bleeding risk reflected the expected pattern based on current evidence.
Cardiologists were more likely to prescribe anticoagulant therapy for AF in the HD population compared to nephrologists, regardless of patient stroke or bleeding risk.
抗栓治疗用于心房颤动（AF）患者的卒中预防被视为一种标准治疗方法，但对于血液透析（HD）患者而言，其益处尚不明确，且出血风险较高。我们的研究目的是比较心脏病专家和肾脏病专家在不同患者风险情况下的卒中预防实践。
对三个加拿大医师协会（肾脏病学、心血管病学、心律协会）的成员以及三所加拿大大学附属的心脏病专家开展了一项横断面在线调查。问卷包含HD患者中四种不同卒中及出血风险的AF情景。针对每种情景，医师需从六种抗栓治疗方案中选择一种。
无论卒中或出血风险如何，心脏病专家选择抗凝治疗而非抗血小板治疗和不进行药物治疗的可能性是肾脏病专家的3倍（p < 0.001）。医师在卒中及出血风险水平方面的药物治疗选择反映了基于当前证据的预期模式。
与肾脏病专家相比，心脏病专家更有可能为HD人群的AF开具抗凝治疗处方，无论患者的卒中或出血风险如何。
