根据估计肾小球滤过率，接受口服抗凝剂治疗的心房颤动患者的出血、血栓形成和死亡风险。
Risk of Bleeding, Thrombosis and Death among Atrial Fibrillation Patients Treated with Oral Anticoagulants Across Estimated Glomerular Filtration Rates.
作者信息
Huang Xinhai, Xie Donglin, Huang Jie, Li Ruijuan, Zheng Qiaowei, Liu Xiumei, Dai Hengfen, Lin Xiangsheng, Liu Yuxin, Su Jun, Dong Xiaomin, Lan Yanxian, You Cuifang, Jiang Shuzheng, Zhang Jinhua
机构信息
School of Pharmacy, Fujian Medical University, Fuzhou, China; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Department of Pharmacy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
出版信息
Am J Cardiol. 2025 Mar 1;238:55-64. doi: 10.1016/j.amjcard.2024.11.033. Epub 2024 Dec 2.
There are limited data about the clinical benefits and harm of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) and chronic kidney disease using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation for glomerular filtration rate (GFR) estimation in nuanced GFR stratification. We conducted a retrospective study in 12 centers in China and included 9,510 patients with AF. We grouped patients into the following estimated GFR (eGFR) categories: ≥60 (n = 7,616), 45 to 59 (n = 1,139), 30 to 44 (n = 474), and <30 (n = 281) ml/min/1.73 m. Logistic regression was used to the compare risks of major bleeding, minor bleeding, total bleeding, thrombosis, and all-cause deaths in patients with AF with eGFR 45 to 59, 30 to 44, <30 ml/min/1.73 m, and ≥60 ml/min/1.73 m after taking OACs. Patients with AF treated with OACs with eGFR 45 to 59, 30 to 44, and <30 ml/min/1.73 m had a significantly increased risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m (adjusted odds ratio [aOR] 1.326, 95% confidence interval [CI] 1.049 to 1.665, p = 0.016; aOR 1.634, 95% CI 1.197 to 2.200, p = 0.002; aOR 2.492, 95% CI 1.766 to 3.471, p <0.001; respectively). Higher eGFR was associated with a significantly lower risk of all-cause deaths (aOR 0.990, 95% CI 0.986 to 0.994, p <0.001) and major bleeding (aOR 0.988, 95% CI 0.979 to 0.998, p = 0.018). Direct OACs remarkably reduced risk of major bleeding in those with eGFR 30 to 44 ml/min/1.73 m compared with warfarin. In conclusion, in patients with AF treated with OACs, patients with eGFR 45 to 59, 30 to 44, and <30 ml/min/1.73 m had a significantly increased risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m, and the risk of all-cause deaths increased with decreasing eGFR. Direct OACs are at least safe alternatives to warfarin in patients with AF with eGFR 30 to 44 ml/min/1.73 m.
关于使用慢性肾脏病流行病学协作组（CKD-EPI）的肌酐方程进行肾小球滤过率（GFR）精细分层估算时，口服抗凝剂（OACs）对心房颤动（AF）合并慢性肾脏病患者预防卒中的临床益处和危害的数据有限。我们在中国的12个中心进行了一项回顾性研究，纳入了9510例AF患者。我们将患者分为以下估算肾小球滤过率（eGFR）类别：≥60（n = 7616）、45至59（n = 1139）、30至44（n = 474）和<30（n = 281）ml/min/1.73m²。采用逻辑回归比较服用OACs后eGFR为45至59、30至44、<30 ml/min/1.73m²和≥60 ml/min/1.73m²的AF患者发生大出血、小出血、总出血、血栓形成和全因死亡的风险。与eGFR≥60 ml/min/1.73m²相比，eGFR为45至59、30至44和<30 ml/min/1.73m²的AF患者服用OACs后全因死亡风险显著增加（校正比值比[aOR] 1.326，95%置信区间[CI] 1.049至1.665，p = 0.016；aOR 1.634，95% CI 1.197至2.200，p = 0.002；aOR 2.492，95% CI 1.766至3.471，p <0.001；分别）。较高的eGFR与显著较低的全因死亡风险（aOR 0.990，95% CI 0.986至0.994，p <0.001）和大出血风险（aOR 0.988，95% CI 0.979至0.998，p = 0.018）相关。与华法林相比，直接OACs显著降低了eGFR为30至44 ml/min/1.73m²患者的大出血风险。总之，在接受OACs治疗的AF患者中，与eGFR≥60 ml/min/1.73m²相比，eGFR为45至59、30至44和<30 ml/min/1.73m²的患者全因死亡风险显著增加，且全因死亡风险随eGFR降低而增加。在eGFR为30至44 ml/min/1.73m²的AF患者中，直接OACs至少是华法林的安全替代药物。
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