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Am J Kidney Dis:慢性肾病患者使用华法林会增加出血风险吗?

2015-05-28 佚名 环球医学资讯

2015年5月,发表于《Am J Kidney Dis》的一篇文章介绍了一项考察慢性肾疾病患者eGFR-INR相互作用对于出血风险影响的研究。结果显示,INR≥4时,eGFR较低的患者出血风险差异较高。此外,由于INR逆转速度较慢,所以出血风险有所延长。背景:慢性肾疾病患者中,抗凝管理非常困难,频繁的超过治疗范围的国际标准化比率(INR≥4)增加出血风险。因此,我们旨在评估,INR和较低的估计肾小

2015年5月,发表于 Am J Kidney Dis 的一篇文章介绍了一项考察慢性肾疾病患者eGFR-INR相互作用对于出血风险影响的研究。结果显示,INR≥4时,eGFR较低的患者出血风险差异较高。此外,由于INR逆转速度较慢,所以出血风险有所延长。

背景:慢性肾疾病患者中,抗凝管理非常困难,频繁的超过治疗范围的国际标准化比率(INR≥4)增加出血风险。因此,我们旨在评估,INR和较低的估计肾小球滤过率(eGFR)的相互作用是否会增加出血风险,以及eGFR较低的患者是否会抗凝逆转时间较长。

研究设计:前瞻性队列研究。

研究设计与受试者:华法林遗传药理学队列(1273名华法林长期使用者);华法林逆转队列(74名INR≥4的住院华法林使用者)。

预测因素:eGFR、INR作为时间依赖协变量,以及二者在遗传药理学队列中的相互作用。逆转队列中的eGFR。

结局和测量:遗传药理学队列中,出血风险(严重、危及生命和致命出血)通过比例风险回归进行评估。逆转队列中,使用线性回归和路径分析对从入组到逆转后的INR、华法林和代谢物浓度、凝血因子(II、VII、IX和X)、PIVKA-II(维生素K缺乏或拮抗剂诱导的蛋白- II)水平等的改变进行评估,从而评估抗凝逆转。

结果:遗传药理学队列中,454人(35.7%)的eGFR<60mL/分/1.73m2。1802人-年的随访期间,119例患者发生了137例次的出血事件(发生率,7.6(95% CI,6.4~8.9)/100人-年)。eGFR较低的患者出现INR≥4的频率较高(P<0.001)。出血风险受到与eGFR-INR相互作用的显著影响。INR<4时,eGFR的出血风险没有差异(所有的P值≥0.4)。INR≥4时,与eGFR≥60mL/分/1.73 m2的患者相比,eGFR为30~44和<30mL/分/1.73 m2的患者的出血风险分别高2.2倍(95% CI,0.8~6.1;P=0.1)和5.8倍(95% CI,2.9~11.4;P<0.001)。逆转队列中,35人(47%)的eGFR<45mL/分/1.73 m2。根据INR(P=0.04)和PIVKA-II(P=0.008)水平的评估,与eGFR≥45mL/分/1.73 m2的患者相比,eGFR<45mL/分/1.73 m2的患者抗凝逆转较慢。

局限性:逆转队列中样本大小有限,缺乏抗生素使用和尿蛋白的数据。

结论:INR≥4时,eGFR较低的患者出血风险差异较高。此外,由于INR逆转速度较慢,所以出血风险有所延长。

原始出处:

Limdi NA1, Nolin TD2, Booth SL3, Centi A3, Marques MB4, Crowley MR5, Allon M6, Beasley TM7.Influence of kidney function on risk of supratherapeutic international normalized ratio-related hemorrhage in warfarin users: a prospective cohort study.Am J Kidney Dis. 2015 May;65(5):701-9. doi: 10.1053/j.ajkd.2014.11.004. Epub 2014 Nov 25.

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    2015-05-31 huaxipanxing

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    2015-05-30 gwc389

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