Anticoagulation in Chronic Kidney Disease.

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY Drugs Pub Date : 2024-10-01 Epub Date: 2024-08-09 DOI:10.1007/s40265-024-02077-6
Marco Montomoli, Boris Gonzales Candía, Adriana Acosta Barrios, Elisa Perez Bernat
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Abstract

The nuanced landscape of anticoagulation therapy in patients with chronic kidney disease (CKD) presents a formidable challenge, intricately balancing the dual hazards of hemorrhage and thrombosis. These patients find themselves in a precarious position, teetering on the edge of these risks due to compromised platelet functionality and systemic disturbances within their coagulation frameworks. The management of such patients necessitates a meticulous approach to dosing adjustments and vigilant monitoring to navigate the perilous waters of anticoagulant therapy. This is especially critical considering the altered pharmacokinetics in CKD, where the clearance of drugs is significantly impeded, heightening the risk of accumulation and adverse effects. In the evolving narrative of anticoagulation therapy, the introduction of direct oral anticoagulants (DOACs) has heralded a new era, offering a glimmer of hope for those navigating the complexities of CKD. These agents, with their promise of easier management and a reduced need for monitoring, have begun to reshape the contours of care, particularly for patients not yet on dialysis. However, this is not without its caveats. The application of DOACs in the context of advanced CKD remains a largely uncharted territory, necessitating a cautious exploration to unearth their true potential and limitations. Moreover, the advent of innovative strategies such as left atrial appendage occlusion (LAAO) underscores the dynamic nature of anticoagulation therapy, potentially offering a tailored solution for those at the intersection of CKD and elevated stroke risk. Yet the journey toward integrating such advancements into standard practice is laden with unanswered questions, demanding rigorous investigation to illuminate their efficacy and safety across the spectrum of kidney disease. In summary, the management of anticoagulation in CKD is a delicate dance, requiring a harmonious blend of precision, caution, and innovation. As we venture further into this complex domain, we must build upon our current understanding, embracing both emerging therapies and the need for ongoing research. Only then can we hope to offer our patients a path that navigates the narrow strait between bleeding and clotting, toward safer and more effective care.

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慢性肾脏病的抗凝治疗。
慢性肾脏病 (CKD) 患者抗凝疗法的微妙变化是一项艰巨的挑战,它错综复杂地平衡着出血和血栓形成的双重危险。由于血小板功能受损和全身凝血功能紊乱,这些患者的处境岌岌可危,徘徊在这些风险的边缘。对这类患者的管理需要对剂量进行细致的调整和警惕性监测,以驾驭抗凝治疗的危险水域。考虑到慢性肾功能衰竭患者的药代动力学发生了改变,药物的清除明显受阻,增加了药物蓄积和不良反应的风险,这一点尤为重要。在抗凝疗法不断发展的过程中,直接口服抗凝剂(DOACs)的问世预示着一个新时代的到来,为那些在复杂的慢性肾脏病治疗过程中的患者带来了一线希望。这些药物有望简化管理并减少监测需求,已开始重塑护理的轮廓,尤其是对尚未接受透析的患者而言。然而,这并非没有注意事项。DOACs 在晚期慢性肾脏病中的应用在很大程度上仍是一个未知领域,需要谨慎探索才能发现其真正的潜力和局限性。此外,左心房阑尾封堵术(LAAO)等创新策略的出现凸显了抗凝治疗的动态性,有可能为处于 CKD 和卒中风险升高交叉点的患者提供量身定制的解决方案。然而,在将这些先进技术纳入标准实践的过程中还存在很多未解之谜,需要进行严格的研究,以阐明其在肾脏疾病中的疗效和安全性。总之,慢性肾脏病患者的抗凝管理是一场微妙的舞蹈,需要精确、谨慎和创新的和谐统一。当我们进一步涉足这一复杂领域时,我们必须以现有的认识为基础,既要接受新兴疗法,又要满足持续研究的需要。只有这样,我们才有希望为患者提供一条在出血和凝血之间的狭窄海峡中航行的道路,从而实现更安全、更有效的治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
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