Thromboembolic and Hemorrhagic Outcomes in the Direct Oral Anticoagulant Trials Across the Spectrum of Kidney Function.
Thromboembolic and Hemorrhagic Outcomes in the Direct Oral Anticoagulant Trials Across the Spectrum of Kidney Function.
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DOI：
10.1002/cpt.2131
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发表时间：
2021-06
影响因子：
6.7
通讯作者：
Florian J
中科院分区：
文献类型：
--
作者：
Limdi NA;Beasley TM;Sun J;Stockbridge N;Pacanowski M;Florian J
慢性肾脏病(CKD)是服用直接作用口服抗凝剂(DOAC)的患者中常见的共病。在此，我们评估了肾功能对服用DOAC和华法林的患者的卒中/SEE、出血和复合终点(卒中/SEE/出血/死亡和卒中/SEE/死亡)的影响。在RE-LY(n=18,049)、亚里士多德(n=18,187)和Engage AF(n=20,798)试验中，参与者的基线肾功能被分类为肾小球滤过率≥60(参考)、45-59和45ml/分钟/1.73m2。事件的发生率在不同GFR类别之间进行了比较。事件的风险比用COX回归估计，使用意向-治疗分析调整已知的预测因素。有很大比例的参与者患有肾小球滤过性肾炎(25%-29%的人患有肾小球滤过性肾炎≥45；60，9.5%-12.6%的人患有肾小球滤过性肾炎)。与肾小球滤过率≥为60的患者相比，在肾小球滤过率≥为45-59和肾小球滤过率为45的试验中，华法林使用者的出血率更高(p值为0.0001)，而在亚里士多德试验和Engage试验中，华法林使用者的中风/SEE发生率更高(p值≤0.05)。与肾小球滤过率≥为60的患者相比，肾小球滤过率≥为45-59和肾小球滤过率为45的患者有更高的中风/SEE(p≤0.02)、出血(p<；0.001)和两个复合终点(p<；0.0001)的发生率。与肾小球滤过率≥为60的患者相比，肾小球滤过率≥为45-59和肾小球滤过率为45的阿皮沙班和依多沙班患者有更高的出血发生率(p值≤0.05)和复合终点(p值≤0.05)。调整后，与肾小球滤过率≥为60的患者相比，在亚里士多德和瑞列试验中，肾小球滤过率为60的华法林患者发生出血的风险更高(p<；0.05)，达比卡特兰(p<；0.001)和依多沙班(p≤0.005)患者也是如此，而服用阿皮沙班的患者没有表现出增加的风险(p=0.08gfr≥45-59；p=0.71gfr<；45)。肾功能对口服抗凝剂的安全性和有效性有重要影响。
Chronic kidney disease (CKD) is a common comorbidity among patients taking direct-acting oral anticoagulants (DOACs). Herein, we evaluate the influence of kidney function on Stroke/SEE, hemorrhage and composite endpoints (Stroke/SEE/hemorrhage/death and Stroke/SEE/death) among patients on DOACs and warfarin. Baseline kidney function was categorized as GFR≥60 (reference), 45-59 and <45ml/min/1.73m2 for participants in the RE-LY (n=18,049), ARISTOTLE (n=18,187), and ENGAGE AF (n=20,798) trials. Incidence of events was compared across GFR categories. Hazard ratios for events was estimated using Cox regression using intention-to-treat analysis adjusting for known predictors. A large proportion of participants had GFR<60 (25-29% had GFR ≥45<60 and 9.5 to 12.6% with GFR <45). Compared to patients with GFR≥60, warfarin users across the trials with GFR≥45-59 and GFR<45 had a higher incidence of hemorrhage (p-values<0.0001) and warfarin users in the ARISTOTLE and ENGAGE trials had higher incidence of stroke/SEE (p-values ≤0.05). Compared to patients with GFR≥60, dabigatran users with GFR≥45-59 and GFR<45 had a higher incidence of stroke/SEE (p≤0.02), hemorrhage (p<0.001) and both composite endpoints (p<0.0001). Compared to patients with GFR≥60, apixaban and edoxaban users with GFR≥45-59 and GFR<45 had a higher incidence of hemorrhage (p-values≤0.05) and composite endpoints (p-values≤0.05). After adjustment, compared to patients with GFR≥60, warfarin users with GFR<60 in the ARISTOTLE and RELY trials had a higher risk of hemorrhage (p<0.05), as did dabigatran (p<0.001) and edoxaban (p≤0.005) users, while apixaban users did not exhibit an increased risk (p=0.08 GFR≥45-59; p=0.71 GFR<45). Kidney function significantly influences the safety and efficacy of oral anticoagulants.
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影响因子：
3.7
作者：
Konstantinidis I;Patel S;Camargo M;Patel A;Poojary P;Coca SG;Nadkarni GN
通讯作者：
Nadkarni GN
DOI：
10.1016/j.amjmed.2015.05.044
发表时间：
2015-12
期刊：
The American journal of medicine
影响因子：
--
作者：
Barnes GD;Lucas E;Alexander GC;Goldberger ZD
通讯作者：
Goldberger ZD
影响因子：
24
作者：
Fang, Margaret C.;Go, Alan S.;Chang, Yuchiao;Borowsky, Leila H.;Pomernacki, Niela K.;Udaltsova, Natalia;Singer, Daniel E.
通讯作者：
Singer, Daniel E.
影响因子：
39.2
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
通讯作者：
Van Lente, Frederick
影响因子：
120.7
作者：
Coresh, Josef;Selvin, Elizabeth;Levey, Andrew S.
通讯作者：
Levey, Andrew S.