Sato Takao, Aizawa Yoshifusa, Kitazawa Hitoshi, Okabe Masaaki
Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
J Atr Fibrillation. 2020 Aug 31;13(2):2308. doi: 10.4022/jafib.2308. eCollection 2020 Aug.
This study aimed to evaluate the characteristics and clinical outcomes (major bleeding [MB] and thromboembolic events [TEEs]) of atrial fibrillation (AF) patients with chronic kidney disease (CKD)who receiveddirect oral anticoagulant (DOAC) therapy.
Data prospectivelycollected from a single-center registry containing 2,272 patients with DOAC prescription for AF (apixaban [n=1,014], edoxaban [n=267], rivaroxaban [n=498], and dabigatran[n=493]) were retrospectively analyzed. Patients were monitored for two years and classified into the CKD (n=1460) andnon-CKD groups(n=812). MB and TEEs were evaluated.
The mean age was 72±10 years, with the CHADS2,CHA2DS2-VASc, and HAS-BLED scores being 1.95±1.32, 3.21±1.67, and 1.89±0.96,respectively.Incidence rates of MB and TEEs were 2.3%/year and 2.1%/year, respectively. The CKD groupwasolderand had lower body weight and higher CHADS2,CHA2DS2-VASc, and HAS-BLED scoresthanthe non-CKD group.Kaplan-Meier curve analysis revealed that the incidence of MB and TEEs was higher in the CKD group. Multiple logistic regression analysis in the CKD group revealed thatage andstroke history were independent determinants of TEEs, and low body weighttended to be a determinant of MB.The inappropriate low dose use was higher for apixaban than other DOACs in the CKD group. Consequently, for apixaban, the incidence of stroke was significantly higherin the CKD group than in the non-CKD group.
Patients with CKDwere characterized by factors that predisposed them to MB and TEEs, such as older age and low body weight. In a single-center registry, only treatment with apixaban in the CKD group led to a higher incidence of TEEs.
本研究旨在评估接受直接口服抗凝剂（DOAC）治疗的慢性肾脏病（CKD）合并心房颤动（AF）患者的特征及临床结局（大出血[MB]和血栓栓塞事件[TEE]）。
对前瞻性收集自单中心登记处的2272例接受DOAC治疗房颤患者（阿哌沙班[n = 1014]、依度沙班[n = 267]、利伐沙班[n = 498]和达比加群[n = 493]）的数据进行回顾性分析。对患者进行两年监测，并分为CKD组（n = 1460）和非CKD组（n = 812）。评估MB和TEE。
平均年龄为72±10岁，CHADS2、CHA2DS2 - VASc和HAS - BLED评分分别为1.95±1.32、3.21±1.67和1.89±0.96。MB和TEE的发生率分别为每年2.3%和2.1%。CKD组比非CKD组年龄更大、体重更低，CHADS2、CHA2DS2 - VASc和HAS - BLED评分更高。Kaplan - Meier曲线分析显示，CKD组MB和TEE的发生率更高。CKD组的多因素逻辑回归分析显示，年龄和卒中史是TEE的独立决定因素，低体重倾向于成为MB的决定因素。CKD组中阿哌沙班不适当低剂量使用比其他DOAC更高。因此，对于阿哌沙班，CKD组卒中发生率显著高于非CKD组。
CKD患者具有使他们易发生MB和TEE的因素，如年龄较大和体重较低。在单中心登记处，CKD组中仅阿哌沙班治疗导致TEE发生率更高。
