Clinic for Nephrology, University Clinical Center Nis, 18000 Nis, Serbia.
Medical Faculty, University of Nis, 18000 Nis, Serbia.
Medicina (Kaunas). 2024 Oct 27;60(11):1760. doi: 10.3390/medicina60111760.
: Patients undergoing chronic hemodialysis (HD) are predisposed to both thrombotic and bleeding complications due to the complex interplay of end-stage renal disease (ESRD), cardiovascular comorbidities, and the routine use of anticoagulant and antiplatelet therapies. This study aimed to investigate the incidence of bleeding and thrombotic events in chronic HD patients receiving anticoagulant and antiplatelet therapy, with a specific focus on those with atrial fibrillation (AF). : A total of 224 patients, with 43 (19%) of them diagnosed with AF, were included in this single-center, observational cohort study conducted over 24 months. The cohort was divided into three groups: patients without anticoagulation, those on warfarin monotherapy, and those on combined warfarin and aspirin therapy. Bleeding events were classified as major, clinically relevant non-major bleeding (CRNMB), or minor bleeding, while thrombotic events included ischemic stroke, myocardial infarction, pulmonary embolism, and arteriovenous fistula thrombosis. : Overall, 35.7% of patients experienced a bleeding event, with major bleeding occurring in 9.4%. Patients with AF had significantly higher rates of major bleeding (18.6%) compared to those without AF (7.18%; = 0.043), especially in the combined therapy group. Mortality due to bleeding was also higher in AF patients (14%). In contrast, thrombotic events occurred in 26.8% of patients, with AF patients experiencing significantly more events (48.8%) compared to non-AF patients (21.5%; = 0.0006). The hazard ratio (HR) for major bleeding in patients on combined warfarin and aspirin therapy was 2.56 ( = 0.016), while the HR for thrombotic events was 2.34 ( = 0.0202). : These findings highlight the increased risks of both bleeding and thrombosis in chronic HD patients with AF, particularly those on combined anticoagulation and antiplatelet therapy.
患者在接受慢性血液透析（HD）治疗时，由于终末期肾脏疾病（ESRD）、心血管合并症以及常规使用抗凝和抗血小板治疗的复杂相互作用，易发生血栓和出血并发症。本研究旨在调查接受抗凝和抗血小板治疗的慢性 HD 患者出血和血栓事件的发生率，特别关注伴有心房颤动（AF）的患者。
本单中心观察性队列研究共纳入 224 例患者，其中 43 例（19%）诊断为 AF。该队列分为三组：未抗凝组、华法林单药治疗组和华法林联合阿司匹林治疗组。出血事件分为主要、临床相关非重大出血（CRNMB）和轻微出血，而血栓事件包括缺血性中风、心肌梗死、肺栓塞和动静脉瘘血栓形成。
总体而言，35.7%的患者发生出血事件，其中 9.4%为大出血。AF 患者的大出血发生率明显高于非 AF 患者（18.6% vs. 7.18%；= 0.043），尤其是联合治疗组。AF 患者因出血导致的死亡率也更高（14%）。相反，26.8%的患者发生血栓事件，AF 患者的血栓事件发生率明显高于非 AF 患者（48.8% vs. 21.5%；= 0.0006）。华法林联合阿司匹林治疗组大出血的风险比（HR）为 2.56（= 0.016），而血栓事件的 HR 为 2.34（= 0.0202）。
这些发现强调了伴有 AF 的慢性 HD 患者出血和血栓形成风险增加，尤其是接受抗凝和抗血小板联合治疗的患者。
