Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
Medicina (Kaunas). 2021 Dec 30;58(1):58. doi: 10.3390/medicina58010058.
: Although the need for anticoagulation to prevent thromboembolism is increasing and non-vitamin K antagonist oral anticoagulants (NOACs) have been tried, there is still controversy about the efficacy of anticoagulation in patients with dialysis. : We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with atrial fibrillation (AF). We retrospectively analyzed all data of 89 patients who received dialysis therapy and were diagnosed with AF. Among them, 27 received anticoagulation (11 warfarin and 16 apixaban 2.5 mg twice a day), while 62 received no anticoagulation. : In multivariate Cox regression analysis, compared to no anticoagulation treatment, anticoagulation treatment was associated with a low incidence of all-cause mortality (hazard ratios (HR) 0.36; 95% confidence interval (CI) 0.15-0.88). Compared to no anticoagulation treatment, more anticoagulation treatment patients experienced severe bleeding (HR 4.67; 95% CI 1.26-17.25) and any bleeding (HR 2.79; 95% CI 1.01-7.74). Compared to no anticoagulation, warfarin treatment patients were associated with a low incidence of all-cause mortality (HR 0.26; 95% CI 0.09-0.81) and a high incidence of severe bleeding (HR 4.85; 95% CI 1.12-21.10). All-cause mortality and bleeding were not significantly different between no anticoagulation and apixaban treatment patients. : In dialysis patients with AF, anticoagulation therapy is associated with an increased incidence of severe bleeding, but anticoagulation therapy is associated with a low incidence of all-cause mortality. Individualized anticoagulation therapy with careful bleeding monitoring is needed in dialysis patients with AF.
虽然预防血栓栓塞的抗凝需求正在增加，且已尝试使用非维生素 K 拮抗剂口服抗凝剂 (NOACs)，但对于透析患者的抗凝疗效仍存在争议。我们回顾性分析了伴房颤 (AF) 的透析患者抗凝的风险和获益。我们回顾性分析了所有接受透析治疗且诊断为 AF 的 89 例患者的数据。其中，27 例接受抗凝治疗（11 例华法林，16 例每日两次服用 2.5mg 阿哌沙班），62 例未接受抗凝治疗。在多变量 Cox 回归分析中，与未抗凝治疗相比，抗凝治疗与全因死亡率降低相关（风险比 (HR) 0.36；95%置信区间 [CI] 0.15-0.88）。与未抗凝治疗相比，更多的抗凝治疗患者发生严重出血（HR 4.67；95% CI 1.26-17.25）和任何出血（HR 2.79；95% CI 1.01-7.74）。与未抗凝治疗相比，华法林治疗患者的全因死亡率降低（HR 0.26；95% CI 0.09-0.81），严重出血发生率较高（HR 4.85；95% CI 1.12-21.10）。未抗凝治疗与阿哌沙班治疗患者的全因死亡率和出血无显著差异。在伴 AF 的透析患者中，抗凝治疗与严重出血发生率增加相关，但抗凝治疗与全因死亡率降低相关。对于伴 AF 的透析患者，需要个体化抗凝治疗并密切监测出血情况。
