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심장내과/부정맥

방 세동의 심박수 조절을 위한 디곡신 사용과 사망 위험 증가

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심방 세동(AF)의 심박수 조절을 위한 디곡신의 역할은 사망률 증가에 대한 우려에 따라 수년간 의문이 제기되어 왔습니다. ARISTOTLE 임상 시험(AF 환자 약 18,000 명에서 항응고제 치료법을 비교한)에 대한 post-hoc subgroup analysis에서 디곡신 사용은 ≥ 1.2 ng / mL 수준에서 사망 위험 증가와 유의한 관련이 있었습니다. 우리는 첫 심박수 조절 약물로서 디곡신을 거의 사용하지 않으며 여기에 다른 속도 조절 약물들을 거의 추가하지 않습니다.

CONCLUSIONS 

Our results indicate that in patients with AF currently taking digoxin, the risk of death was independently related to serum digoxin concentration, with a significantly higher risk in patients with concentrations ≥1.2 ng/ml. Initiating digoxin treatment in patients with AF was independently associated with higher mortality, regardless of heart failure status. Thus, in the absence of randomized trial data showing its efficacy and safety, digoxin should be used with caution and with monitoring of its serum concentration in patients with AF, and should preferably be avoided if symptoms can be alleviated with other treatments.

REF. UpToDate 2018.05.06
        J Am Coll Cardiol. 2018;71(10):1063. 


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