口服抗凝药用于预防心房动和晚期病中的中风
Ellen Linnea Freese Ballegaard1,2, Jonas Bjerring Olesen3, Anne-Lise Kamper1
1Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Research and practice in thrombosis and haemostasis
|March 14, 2024
概括
口服抗凝剂 (OAC) 在晚期慢性病患者心房动减少了血栓栓塞事件和死亡,但增加了重大出血风险. 这凸显了这些高风险人群的复杂的利益风险平衡.
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:
- 在患有晚期慢性病 (CKD) 和心房动 (AF) 的患者中,口服抗凝剂 (OAC) 的净益处尚未得到充分确立.
- 包括透析患者在内的估计淋巴细胞过率 (eGFR) <30mL/min/1.73m2的患者,代表了抗凝治疗的复杂人群.
研究的目的:
- 评估OAC在晚期CKD和AF患者中的利用,有效性和安全性.
- 为了比较治疗和未治疗患者之间的血栓栓塞事件,严重出血和死亡的一年风险.
主要方法:
- 使用丹麦国家登记册 (2010-2022) 的回顾性队列研究.
- 纳入标准:确诊的AF和eGFR<30毫升/分钟/1.73米2.
- 通过处方赎回识别的OAC启动;启动后一年评估结果.
主要成果:
- 包括3208名患者 (平均年龄80岁,20.9%接受透析).
- 在42.9%的患者中,OAC开始使用维生素K抗剂或直接口服抗凝剂.
- 与没有OAC相比,抗凝血与一年内血栓栓塞事件 (3.6%与4.8%) 和死亡 (29.6%与36.3%) 的风险较低,但较大出血风险较高 (10.5%与7.6%).
结论:
- 在晚期CKD和AF患者中,OAC与血栓栓塞事件和死亡的1年风险降低有关.
- 这一好处被增加的一年大出血风险所抵消.
- 这些发现强调了OAC在这个特定的患者群体中的复杂的风险-益处概况.
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