摘要
目的 探讨华法林用于终末期肾病行血液透析并心房颤动(房颤)患者抗凝治疗的有效性及安全性。 方法 2013年2月至2016年6月于武汉大学人民医院住院治疗的终末期肾病行血液透析的118例房颤患者中,出院后53例口服华法林治疗(华法林组)、65例未服华法林(非华法林组)。华法林组:出院后3 mg开始口服,每日1次,将国际标准化比值(INR)控制在2.0~3.0;非华法林组:出院后不使用任何抗凝药物。患者出院后定期门诊或电话随访,随访内容主要包括缺血性脑卒中事件、大出血事件、死亡事件。 结果 (1)两组患者基线资料(年龄、性别、基础疾病、非瓣膜性房颤患者卒中风险预测评分、非瓣膜性房颤患者出血风险预测评分、透析频率)比较差异无统计学意义(均P>0.05)。(2)华法林组6例(11%)、非华法林组8例(12%)发生脑缺血性卒中,两组比较差异无统计学意义(χ^2=0.027,P=0.87)。(3)华法林组5例(9%)、非华法林组3例(5%)发生大出血事件,两组比较差异无统计学意义(P=0.47),主要原因均为胃肠道出血,其中华法林组3例(6%)、非华法林组胃肠道出血2例(3%),两组比较差异无统计学意义(P=0.66)。(4)华法林组10例(15%)、非华法林组14例(22%)死亡,两组比较差异无统计学意义(χ^2=0.129,P=0.72);主要原因均为心源性死亡,其中华法林组5例(9%)、非华法林组7例(11%),两组比较差异无统计学意义(χ^2=0.057,P=0.81)。 结论 终末期肾病行血液透析的房颤患者口服华法林治疗缺血性脑卒中的发生未降低。
Objective To evaluate the efficacy and safety of anticoagulant therapy with warfarin for hemodialysis patients with atrial fibrillation. Methods A cohort of 118 hemodialysis patients with atrial fibrillatio were enrolled. The patients were divided into two groups: in warfarin group (n=53) the standard medication of warfarin was given for at least 3 months by adjusting the INR between 2.0 and 3.0;while no anticoagulants were given after discharge in non-warfarin group (n=65). Patients were followed up regularly, the events of stoke, death and bleeding were documented and compared between two groups. Results There were no significant differences in age, sex, underlying disease, predictive score of stroke risk in patients with non-valvular atrial fibrillation (CHA2DS2-VASc), predictive score of bleeding risk in patients with non-valvular atrial fibrillation (HAS-BLED) and dialysis frequency between the two groups (P>0.05). There were no significant differences in events of ischemic stroke [11%(6/53) vs. 12%(8/65), χ^2=0.027, P=0.87], bleedings [(9%(5/53) vs. 5%(3/65), P=0.46] and gastrointestinal bleeding events [6%(3/53) vs. 3% (2/65), P=0.66] between two groups. There were no significant differences in the death event [15%(10/53) vs. 22%(14/65), χ^2=0.129, P=0.72] and cardiac death [9%(5/53) vs. 11%(7/65), χ^2=0.057, P=0.81] between two groups. Conclusion This study suggests that warfarin may not prevent ischemic stroke in hemodialysis patients with chronic atrial fibrillation, further studies are needed to determine the risks and benefits of anticoagulation therapy in these patients.
作者
王光记
孔彬
刘育
黄鹤
Wang Guangji;Kong Bin;Liu Yu;Huang He(Department of Cardiology,Renmin Hospital of Wuhan University,Cardiovascular Research Institute of Wuhan University,Hubei Key Laboratory of Cardiology,Wuhan 430060,China)
出处
《中华全科医师杂志》
2019年第2期161-165,共5页
Chinese Journal of General Practitioners
基金
湖北省公益性项目(NO2013BCB013).
关键词
华法林
肾透析
心房颤动
卒中
出血
死亡
Warfarin
Renal dialysis
Atrial fibrillation
Stroke
Hemorrhage
Death
