When anticoagulation management in atrial fibrillation becomes difficult: Focus on chronic kidney disease, coagulation disorders, and cancer

IF 6.9 2区 医学 Q1 HEMATOLOGY Blood Reviews Pub Date : 2024-01-14 DOI:10.1016/j.blre.2024.101171
Panteleimon E. Papakonstantinou , Vasiliki Kalogera , Dimitrios Charitos , Dimitrios Polyzos , Dimitra Benia , Athina Batsouli , Konstantinos Lampropoulos , Sotirios Xydonas , Dhiraj Gupta , Gregory Y.H. Lip
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Abstract

Anticoagulation therapy (AT) is fundamental in atrial fibrillation (AF) treatment but poses challenges in implementation, especially in AF populations with elevated thromboembolic and bleeding risks. Current guidelines emphasize the need to estimate and balance thrombosis and bleeding risks for all potential candidates of antithrombotic therapy. However, administering oral AT raises concerns in specific populations, such as those with chronic kidney disease (CKD), coagulation disorders, and cancer due to lack of robust data. These groups, excluded from large direct oral anticoagulants trials, rely on observational studies, prompting physicians to adopt individualized management strategies based on case-specific evaluations. The scarcity of evidence and specific guidelines underline the need for a tailored approach, emphasizing regular reassessment of risk factors and anticoagulation drug doses. This narrative review aims to summarize evidence and recommendations for challenging AF clinical scenarios, particularly in the long-term management of AT for patients with CKD, coagulation disorders, and cancer.

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当心房颤动的抗凝管理变得困难时:关注慢性肾病、凝血功能障碍和癌症
抗凝疗法(AT)是心房颤动(AF)治疗的基础,但在实施过程中却面临挑战,尤其是在血栓栓塞和出血风险较高的心房颤动人群中。现行指南强调,需要对所有潜在的抗血栓治疗对象进行血栓栓塞和出血风险的评估和平衡。然而,由于缺乏可靠的数据,口服抗凝血药物在特定人群中的应用引起了关注,如慢性肾病(CKD)患者、凝血功能障碍患者和癌症患者。这些群体被排除在大型 DOAC 试验之外,只能依靠观察性研究,促使医生根据具体病例的评估采取个性化的管理策略。证据和具体指南的缺乏凸显了采取量身定制方法的必要性,强调定期重新评估风险因素和抗凝药物剂量。本叙述性综述旨在总结具有挑战性的房颤临床情况的证据和建议,尤其是在对患有慢性肾脏病、凝血功能障碍和癌症的患者进行长期房颤管理时。
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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
期刊最新文献
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