- MeSH
- antikoagulancia terapeutické užití MeSH
- cévní mozková příhoda epidemiologie MeSH
- chronická renální insuficience diagnóza epidemiologie mortalita terapie MeSH
- chronické selhání ledvin diagnóza epidemiologie mortalita terapie MeSH
- fibrilace síní diagnóza epidemiologie farmakoterapie mortalita MeSH
- hodnocení rizik MeSH
- komorbidita MeSH
- lidé MeSH
- rizikové faktory MeSH
- transplantace ledvin MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
There is a growing number of patients returning to dialysis after a failed kidney transplant, and there is increasing evidence of higher mortality among this population. Whether removal of the failed renal allograft affects survival while receiving long-term dialysis is not well understood. We identified all adults who received a kidney transplant and returned to long-term dialysis after renal allograft failure between January 1994 and December 2004 from the US Renal Data System. Among 10,951 transplant recipients who returned to long-term dialysis, 3451 (31.5%) received an allograft nephrectomy during follow-up. Overall, 34.6% of these patients died during follow-up. Receiving an allograft nephrectomy associated with a 32% lower adjusted relative risk for all-cause death (adjusted hazard ratio 0.68; 95% confidence interval 0.63 to 0.74) after adjustment for sociodemographic characteristics, comorbidity burden, donor characteristics, interim clinical conditions associated with receiving allograft nephrectomy, and propensity to receive an allograft nephrectomy. In conclusion, within a large, nationally representative sample of high-risk patients returning to long-term dialysis after failed kidney transplant, receipt of allograft nephrectomy independently associated with improved survival.
- MeSH
- chronické selhání ledvin chirurgie MeSH
- homologní transplantace MeSH
- ledviny chirurgie MeSH
- lidé MeSH
- míra přežití MeSH
- nefrektomie MeSH
- příčina smrti MeSH
- rejekce štěpu mortalita MeSH
- retrospektivní studie MeSH
- transplantace ledvin MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Spojené státy americké MeSH
Guidelines recommend warfarin use in patients with atrial fibrillation solely on the basis of risk for ischemic stroke without antithrombotic therapy. These guidelines rely on ischemic stroke rates observed in older trials and do not explicitly account for increased risk for hemorrhage. OBJECTIVE: To quantify the net clinical benefit of warfarin therapy in a cohort of patients with atrial fibrillation. DESIGN: Mixed retrospective and prospective cohort study of patients with atrial fibrillation between 1996 and 2003. SETTING: An integrated health care delivery system. PATIENTS: 13 559 adults with nonvalvular atrial fibrillation. MEASUREMENTS: Warfarin exposure, patient characteristics, CHADS(2) score (1 point for each of congestive heart failure, hypertension, age, and diabetes and 2 points for stroke), and outcome events were ascertained from health plan records and databases. Net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by warfarin minus intracranial hemorrhages attributable to warfarin, multiplied by an impact weight. The base-case impact weight was 1.5, reflecting the greater clinical impact of intracranial hemorrhage versus thromboembolism. RESULTS: Patients accumulated more than 66 000 person-years of follow-up. The adjusted net clinical benefit of warfarin for the cohort overall was 0.68% per year (95% CI, 0.34% to 0.87%). Adjusted net clinical benefit was greatest for patients with a history of ischemic stroke (2.48% per year [CI, 0.75% to 4.22%]) and for those 85 years or older (2.34% per year [CI, 1.29% to 3.30%]). The net clinical benefit of warfarin increased from essentially zero in CHADS(2) stroke risk categories 0 and 1 to 2.22% per year (CI, 0.58% to 3.75%) in CHADS(2) categories 4 to 6. The patterns of results were preserved when weighting factors for intracranial hemorrhage of 1.0 and 2.0 were used. LIMITATIONS: Residual confounding is a possibility. Some outcome events were probably missed by the screening algorithm or when medical records were unavailable. CONCLUSION: Expected net clinical benefit of warfarin therapy is highest among patients with the highest untreated risk for stroke, which includes the oldest age category. Risk assessment that incorporates both risk for thromboembolism and risk for intracranial hemorrhage provides a more quantitatively informed basis for the decision on antithrombotic therapy in patients with atrial fibrillation. PRIMARY FUNDING SOURCE: National Institute on Aging; National Heart, Lung, and Blood Institute; and Massachusetts General Hospital.
- MeSH
- antikoagulancia aplikace a dávkování MeSH
- fibrilace síní komplikace MeSH
- financování organizované MeSH
- intrakraniální krvácení prevence a kontrola MeSH
- ischemie mozku prevence a kontrola MeSH
- lidé MeSH
- prospektivní studie MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- sekundární prevence MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tromboembolie prevence a kontrola MeSH
- věkové faktory MeSH
- warfarin aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- cévní mozková příhoda prevence a kontrola MeSH
- dospělí MeSH
- fibrilace síní farmakoterapie patologie MeSH
- finanční podpora výzkumu jako téma MeSH
- hodnocení léčiv MeSH
- lidé MeSH
- senioři MeSH
- tromboembolie farmakoterapie patologie MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- warfarin farmakologie terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
