Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Medicina (Kaunas). 2020 May 28;56(6):266. doi: 10.3390/medicina56060266.
Recent randomized trials of oral antithrombotic drugs with atrial flutter (AFL) excluded patients with renal impairment because of their increased risk of bleeding. To date, no relevant studies have assessed the effectiveness and safety of different antithrombotic drugs in chronic kidney disease (CKD) patients with AFL. This cohort study evaluated the effectiveness and safety of different antithrombotic drugs in CKD patients with AFL. This study also investigated the risk of cardiovascular events from antithrombotic drugs through different risk profiles of stroke stratified by the CHADS-VASc score. This cohort study was performed in patients with AFL and CKD who were extracted from the National Health Insurance (NHI) Database in Taiwan. Oral antithrombotic therapy (oral anticoagulants (OAC) or antiplatelets (APT)) was administered to patients who had been diagnosed with AFL after being diagnosed with CKD between 2011 and 2015. Primary outcomes, including ischemic stroke, systemic embolism, and composite of stroke, and secondary outcomes, including major adverse cardiac events (MACEs), major bleeding, all-cause mortality, and cardiovascular-related death, were examined. : A total of 2468 patients were included in this study. The results showed no statistically significant differences in the risk of primary outcomes. For the secondary outcomes, there were also no statistically significant differences in the risk of MACEs and major bleeding. However, the pooled results indicated that the hazard ratio (HR) for all-cause mortality with OAC was 0.24 (95% confidence interval (CI) = 0.10-0.55) compared with combination therapy, and the HR for APT compared with OAC was 2.86 (95% CI = 1.48-5.53). In the studied population, OAC or APT alone were proved equally effective for stroke prophylaxis. Furthermore, OAC might reduce the all-cause mortality rate compared with APT and should be considered as the first choice of oral antithrombotic drugs in patients with AFL and CKD.
最近的伴有心房颤动（AFL）的口服抗血栓药物的随机试验因出血风险增加而排除了肾功能损害的患者。迄今为止，尚无相关研究评估不同抗血栓药物在伴有 AFL 的慢性肾脏病（CKD）患者中的有效性和安全性。这项队列研究评估了不同抗血栓药物在伴有 AFL 的 CKD 患者中的有效性和安全性。该研究还通过 CHADS-VASc 评分分层的中风风险概况，研究了抗血栓药物的心血管事件风险。
这项队列研究是在从台湾国民健康保险（NHI）数据库中提取的伴有 AFL 和 CKD 的患者中进行的。口服抗血栓治疗（口服抗凝剂（OAC）或抗血小板药物（APT））给予 2011 年至 2015 年期间被诊断为 CKD 后诊断为 AFL 的患者。主要结局包括缺血性中风、全身性栓塞和中风复合，次要结局包括主要不良心脏事件（MACEs）、大出血、全因死亡率和心血管相关死亡。：共有 2468 名患者纳入本研究。结果显示，主要结局风险无统计学差异。对于次要结局，MACE 和大出血的风险也无统计学差异。然而，汇总结果表明，与联合治疗相比，OAC 的全因死亡率的危险比（HR）为 0.24（95%置信区间（CI）=0.10-0.55），而与 OAC 相比，APT 的 HR 为 2.86（95%CI=1.48-5.53）。在研究人群中，OAC 或 APT 单独使用均可有效预防中风。此外，与 APT 相比，OAC 可能降低全因死亡率，应考虑将其作为伴有 AFL 和 CKD 患者的首选口服抗血栓药物。
