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华法林与直接口服抗凝剂相关肾损伤危险因素的差异:日本药物不良反应报告数据库分析。

Differences in risk factors for anticoagulant-related nephropathy between warfarin and direct oral anticoagulants: Analysis of the Japanese adverse drug event report database.

机构信息

Department of Pharmacy, Kaetsu Hospital, Niigata, Japan.

Department of Clinical Pharmacology and Therapeutics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.

出版信息

Br J Clin Pharmacol. 2021 Jul;87(7):2977-2981. doi: 10.1111/bcp.14688. Epub 2020 Dec 18.

Abstract

Limited information is available on anticoagulant-related nephropathy (ARN). We therefore reviewed the Japanese Adverse Drug Event Report database to investigate kidney injury (KI) in patients administered warfarin or direct oral anticoagulants (DOACs) and sought to clarify the risk factors for ARN. KI risk in warfarin users was associated with male sex (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.35-2.13; P < .01) and age ≥80 years (OR, 1.35; 95% CI, 1.07-1.72; P = .01). KI risk in DOAC users was associated with body weight ≥80 kg (OR, 1.60; 95% CI, 1.01-2.53; P = .04) and use of dabigatran (OR, 1.61; 95% CI, 1.09-2.37; P < .01). Our findings suggest that risk factors for ARN differ between warfarin and DOACs and that these risk factors may be associated with bleeding risk. Therefore, the risk of ARN may be decreased by better managing bleeding risk in patients taking anticoagulants.

摘要

关于抗凝相关肾病 (ARN) 的信息有限。因此,我们回顾了日本药物不良反应报告数据库,以调查接受华法林或直接口服抗凝剂 (DOAC) 治疗的患者的肾脏损伤 (KI),并试图阐明 ARN 的危险因素。华法林使用者的 KI 风险与男性性别相关 (比值比 [OR],1.70;95%置信区间 [CI],1.35-2.13;P<0.01) 和年龄≥80 岁 (OR,1.35;95% CI,1.07-1.72;P=0.01)。DOAC 使用者的 KI 风险与体重≥80kg 相关 (OR,1.60;95% CI,1.01-2.53;P=0.04) 和使用达比加群 (OR,1.61;95% CI,1.09-2.37;P<0.01)。我们的研究结果表明,ARN 的危险因素在华法林和 DOAC 之间存在差异,这些危险因素可能与出血风险相关。因此,通过更好地管理抗凝治疗患者的出血风险,ARN 的风险可能会降低。

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