末期病和心房动患者的抗凝药:一项基于全国人口的研究
Deok-Gie Kim1, Sung Hwa Kim2,3, Sung Yong Park4
1Department of Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
Clinical kidney journal
|March 1, 2024
概括
在末期病 (ESKD) 和心房动 (AF) 患者中,口服抗凝剂 (OAC) 的使用与降低死亡率和中风风险有关. 这些发现表明,OAC可以改善这一高风险人群的结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在末期病 (ESKD) 患者中,心房动 (AF) 的高且不断增加的患病率.
- 在这个人群中,关于口服抗凝剂 (OAC) 使用的证据不足且相互矛盾.
研究的目的:
- 评估OAC使用与ESKD和AF患者的临床结果之间的关联.
主要方法:
- 使用韩国国家健康保险系统 (2007-2017) 进行的回顾性队列研究.
- 包括在ESKD发病后被诊断为AF的患者.
- 主要结局:全因死亡. 二次结果:缺血性中风,严重出血住院治疗,MACE.
- 倾向性得分匹配 (PSM) 和里程碑分析比较了OAC用户和非用户.
主要成果:
- OAC的处方数量显著增加,直接OAC的数量增加.
- 在PSM之后,OAC使用者显示所有原因死亡风险较低 (HR 0.67),缺血性中风 (HR 0.61) 和MACE (HR 0.70).
- 与OACs一起没有观察到严重出血住院的风险增加 (HR 0.99).
- 与华法林不同的是,直接的OAC与减少死亡和出血住院有关.
结论:
- 在患有AF的ESKD患者中,OAC与减少全因死亡,缺血性中风和MACE有关.
- 直接的OAC可能在这个群体中提供有利的风险-收益概况.
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