El uso de warfarina y el riesgo de accidente cerebrovascular y sangrado en pacientes con fibrilación auricular sometidos a diálisis

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Mitesh Shah¹, Meytal Avgil Tsadok, Cynthia A Jackevicius

¹Divisions of Clinical Epidemiology and General Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada (M.S., M.A.T., NE.R., H.B., L.P._; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (C.A.J.); Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada (V.E.); Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada (M.J.E.); Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada (K.H.H.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada (J.V.T.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (H.G.).

|January 24, 2014

Resumen

El uso de warfarina en pacientes con fibrilación auricular (FA) sometidos a diálisis no redujo el riesgo de accidente cerebrovascular, pero aumentó el riesgo de hemorragia. Este hallazgo contrasta con los beneficios observados en pacientes sin diálisis, destacando una diferencia crítica en los resultados del tratamiento.

Área de la Ciencia:

Nefrología Nefrología.
Cardiología Cardiología.
Farmacología Farmacología.

Sus antecedentes:

Los estudios de observación sobre el uso de warfarina en pacientes con fibrilación auricular (FA) sometidos a diálisis han dado resultados contradictorios con respecto a los riesgos de accidente cerebrovascular y sangrado.
Los pacientes con FA en diálisis representan una población vulnerable con comorbilidades complejas.

Objetivo del estudio:

Investigar la asociación entre el uso de warfarina y el riesgo de accidente cerebrovascular y sangrado en pacientes ancianos con FA que se someten a diálisis.
Para comparar estos riesgos entre los grupos de pacientes con y sin diálisis.

Principales métodos:

Un estudio de cohorte retrospectivo basado en la población se llevó a cabo en Quebec y Ontario, Canadá, de 1998 a 2007.
Se incluyeron pacientes de ≥65 años de edad con FA, categorizados en grupos de diálisis (hemodiálisis y diálisis peritoneal) y no diálisis.
El uso de warfarina se definió por la primera prescripción rellenada dentro de los 30 días posteriores al alta hospitalaria de la FA; los resultados incluyeron accidentes cerebrovasculares y eventos de sangrado. Se calcularon los ratios de peligro ajustados.

Principales resultados:

El estudio incluyó a 1626 pacientes en diálisis y 204.210 pacientes sin diálisis.
Entre los pacientes en diálisis, el uso de warfarina no se asoció con un riesgo reducido de accidente cerebrovascular (HR, 1,14; IC del 95%, 0,78-1,67).
El uso de warfarina se asoció con un 44% más de riesgo de sangrado en pacientes en diálisis (aHR, 1.44; IC del 95%, 1.13-1.85). Los ajustes de puntuación de propensión confirmaron estos hallazgos.

Conclusiones:

El tratamiento con warfarina en pacientes con AF sometidos a diálisis no se asocia con un riesgo reducido de accidente cerebrovascular.
El uso de warfarina en esta población está relacionado con un mayor riesgo de eventos hemorrágicos.
Estos hallazgos sugieren que las estrategias actuales de anticoagulación pueden necesitar una reevaluación para los pacientes con AF en diálisis.

Palabras clave:

La fibrilación auricular es una fibrilación auricular.La diálisis es la diálisis.La hemorragia es una hemorragia.El golpe del golpe del golpe del golpe del golpe.en el Warfarin.

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