Hsu Chia-Chen, Chen Cheng-Chi, Chou Chian-Ying, Chen Kuan-Hsuan, Wang Sheng-Fan, Chang Shih-Lin, Chang Yuh-Lih
Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taipei, Taiwan.
Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Thromb Thrombolysis. 2023 Nov;56(4):518-528. doi: 10.1007/s11239-023-02859-x. Epub 2023 Jul 15.
The effectiveness and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and advanced kidney disease (AKD) has not been fully established.
To determine the effectiveness and safety related to pooled or specific DOACs to that with warfarin in patients with AF and AKD.
Patients with AF and AKD (estimated glomerular filtration rate < 30 mL/min) who received DOAC or warfarin from July 2011 to December 2020 were retrospectively identified in a medical center in Taiwan. Primary outcomes were hospitalized for stroke/systemic embolism and major bleeding. Secondary outcomes included any ischemia and any bleeding.
A total of 1,011 patients were recruited, of whom 809 (80.0%) were in the DOACs group (15.3% dabigatran, 25.4% rivaroxaban, 25.2% apixaban, and 14.1% edoxaban), and 202 (20.0%) in the warfarin group. DOACs had considerably lower risks of stroke/systemic embolism (adjusted hazard ratio [aHR] 0.29; 95% CI, 0.09-0.97) and any ischemia (aHR, 0.42; 95% CI, 0.22-0.79), but had comparable risks of major bleeding (aHR, 0.99; 95% CI, 0.34-2.92) and any bleeding (aHR, 0.74; 95% CI, 0.50-1.09) than warfarin. Apixaban was linked to considerably lower risks of any ischemia (aHR, 0.13; 95% CI, 0.04-0.48) and any bleeding (aHR, 0.53; 95% CI, 0.28-0.99) than warfarin.
Among patients with AF and AKD, DOACs were linked to a lower risk of ischemic events, and apixaban was linked to a lower risk of any ischemia and any bleeding than warfarin.
直接口服抗凝剂（DOACs）在心房颤动（AF）和晚期肾病（AKD）患者中的有效性和安全性尚未完全确立。
确定与华法林相比，合并使用或特定DOACs在AF和AKD患者中的有效性和安全性。
回顾性纳入2011年7月至2020年12月在台湾某医疗中心接受DOAC或华法林治疗的AF和AKD患者（估计肾小球滤过率<30 mL/min）。主要结局为因中风/全身性栓塞和大出血住院。次要结局包括任何缺血事件和任何出血事件。
共纳入1011例患者，其中809例（80.0%）在DOACs组（达比加群15.3%、利伐沙班25.4%、阿哌沙班25.2%、依度沙班14.1%），202例（20.0%）在华法林组。DOACs发生中风/全身性栓塞（校正风险比[aHR]0.29；95%CI，0.09 - 0.97）和任何缺血事件（aHR，0.42；95%CI，0.22 - 0.79）的风险显著较低，但与华法林相比，大出血（aHR，0.99；95%CI，0.34 - 2.92）和任何出血事件（aHR，0.74；95%CI，0.50 - 1.09）的风险相当。与华法林相比，阿哌沙班发生任何缺血事件（aHR，0.13；95%CI，0.04 - 0.48）和任何出血事件（aHR，0.53；95%CI，0.28 - 0.99）的风险显著较低。
在AF和AKD患者中，DOACs与较低的缺血事件风险相关，且与华法林相比，阿哌沙班与较低的任何缺血事件和任何出血事件风险相关。
