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연세대학교 의과대학 Yonsei Medical Journal Yonsei Medical Journal 제60권 제1호
발행연도
2019.1
수록면
65 - 72 (8page)

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Purpose: Antithrombotic therapy could be related with nuisance bleeding. This study investigated whether vitreous hemorrhage(VH) is associated with specific types of antithrombotic medication in patients with atrial fibrillation (AF). Materials and Methods: In the Korean National Health Insurance Service National Sample Cohort, we identified 9352 antiplatelet/anticoagulant-treated AF patients. The occurrence of VH was compared between warfarin (n=1493) and a propensity score (PS)-matched antiplatelet group (n=1493) and between warfarin (n=1493) and a PS-matched warfarin+antiplatelet group (n=1493). Results: The outcomes of VH were lower in the warfarin than in the matched antiplatelet (1.45 vs. 3.72 events/1000 patient-years)and matched warfarin+antiplatelet groups (1.45 vs. 6.87 events/1000 patient-years). Compared with warfarin, the risk of VH increasedwith antiplatelet [adjusted hazard ratio (aHR) 3.90; 95% confidence interval (CI) 1.22–12.4, p=0.022] and warfarin+antiplateletagents (aHR 4.39, 95% CI 1.74–11.2, p=0.002). Compared with warfarin only, warfarin+antiplatelet agents increased the risk of VHin patients ≥65 years, regardless of gender and hypertension. The risk of VH was significantly higher with dual antiplatelet therapy(aHR: 5.02, 95% CI: 1.56–16.2, p=0.007) or in dual (aHR: 5.02, 95% CI: 1.74–14.5, p=0.003) or triple therapy using warfarin and antiplateletagents than with warfarin monotherapy (aHR: 6.12, 95% CI: 1.76–21.3, p=0.004). Conclusion: Dual antiplatelet or triple therapy increased the risk of VH significantly, compared to warfarin monotherapy. Consideringthe low efficacy of preventing ischemic stroke and high risk of bleeding, dual or triple therapy using warfarin and antiplateletagents should be avoided to prevent VH in AF patients.

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