心房颤动和慢性肾病患者的口服抗凝药使用:综述。

IF 2.8 3区 医学 Q2 UROLOGY & NEPHROLOGY Seminars in nephrology Pub Date : 2024-03-01 DOI:10.1016/j.semnephrol.2024.151517
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引用次数: 0

摘要

心房颤动(房颤)在慢性肾脏病(CKD)患者中发病率很高。心房颤动与中风风险增加有关,而中风风险会随着肾功能下降而增加。在普通人群和中度 CKD 患者(肌酐清除率 30-50 mL/min)中,使用口服抗凝药以降低中风风险一直是标准的治疗方法,其依据是开创性的随机对照试验中确立的良好风险-获益关系。然而,在重度慢性肾脏病患者(肌酐清除率为 30-50 毫升/分钟)中,使用口服抗凝药预防中风的证据并不明确。
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Oral Anticoagulation Use in Individuals With Atrial Fibrillation and Chronic Kidney Disease: A Review

Atrial fibrillation (AF) is highly prevalent in patients with chronic kidney disease (CKD). It is associated with an increased risk of stroke, which increases as kidney function declines. In the general population and in those with a moderate degree of CKD (creatinine clearance 30-50 mL/min), the use of oral anticoagulation to decrease the risk of stroke has been the standard of care based on a favorable risk–benefit profile that had been established in seminal randomized controlled trials. However, evidence regarding the use of oral anticoagulants for stroke prevention is less clear in patients with severe CKD (creatinine clearance <30 mL/min) and those receiving maintenance dialysis, as these individuals were excluded from such large randomized controlled trials. Nevertheless, the direct oral anticoagulants have invariably usurped vitamin K antagonists as the preferred choice for oral anticoagulation among patients with AF across all strata of CKD based on their well-defined safety and efficacy and multiple pharmacokinetic benefits (e.g., less drug–drug interactions). This review summarizes the current literature on the role of oral anticoagulation in the management of AF among patients with CKD and highlights current deficiencies in the evidence base and how to overcome them.

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来源期刊
Seminars in nephrology
Seminars in nephrology 医学-泌尿学与肾脏学
CiteScore
5.60
自引率
0.00%
发文量
27
审稿时长
6-12 weeks
期刊介绍: Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to the clinical practice of nephrology. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training.
期刊最新文献
Table of Contents Editorial Board Masthead Electronic Collection of Patient-Reported Outcomes to Improve Kidney Care: Benefits, Drawbacks, and Next Steps Patient-Reported Outcomes to Achieve Person-Centered Care for Aging People With Kidney Disease
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