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심방세동과 말기 콩팥병이 동반된 환자에서 와파린과 항혈소판 요법의 안전성과 효과 비교

Comparison of the Efficacy and Safety of Warfarin and Antiplatelet Therapy in Patients with Atrial Fibrillation and End-Stage Renal Disease

대한내과학회지 2019년 94권 2호 p.191 ~ 199
한동희 ( Han Dong-Hee ) - 연세대학교 의과대학 세브란스병원 심장내과

엄재선 ( Uhm Jae-Sun ) - 연세대학교 의과대학 세브란스병원 심장내과
박정탁 ( Park Jung-Tak ) - 연세대학교 의과대학 세브란스병원 신장내과
김태훈 ( Kim Tae-Hoon ) - 연세대학교 의과대학 세브란스병원 심장내과
정보영 ( Joung Bo-Young ) - 연세대학교 의과대학 세브란스병원 심장내과
유태현 ( Yoo Tae-Hyun ) - 연세대학교 의과대학 세브란스병원 신장내과
박희남 ( Park Hui-Nam ) - 연세대학교 의과대학 세브란스병원 심장내과
강신욱 ( Kang Shin-Wook ) - 연세대학교 의과대학 세브란스병원 신장내과
이문형 (  ) - 연세대학교 의과대학 세브란스병원 심장내과

Abstract

Background/Aims: The optimal strategy for anticoagulation treatment in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has not been established. We evaluated the efficacy and bleeding risk of warfarin and antiplatelet agents in patients with AF and ESRD.

Methods: We retrospectively reviewed the medical records of 256 patients with AF and ESRD and included 158 patients (age, 63.7 ± 12.2 years; male sex, n = 103) with a CHA2DS2-VASc score ≥ 1 who were taking warfarin (n = 53) or an antiplatelet agent (n = 105).

Results: During the follow-up period (31.0 ± 29.4 months), 10 ischemic events and 29 major bleeding events occurred. The thromboembolic event rate did not significantly differ between the warfarin and antiplatelet groups (1.9% and 8.6%, respectively; p = 0.166). However, the rate of major bleeding events was significantly higher in the warfarin group than it was in the antiplatelet group (32.1% and 11.4%, respectively; p = 0.002). Cox’s regression analysis indicated that warfarin was related to an increased risk of major bleeding events (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.60-7.36; p = 0.001). Conversely, warfarin was not related to a decreased risk of thromboembolic events (HR, 0.34; 95% CI, 0.04-2.70; p = 0.306).

Conclusions: In patients with AF and ESRD, warfarin use was associated with an increased risk of bleeding events, compared with antiplatelet agents.

키워드

Atrial fibrillation; Kidney failure, Chronic; Anticoagulants; Warfarin
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