Hamad Medical Corp., Doha, Qatar.
Expert Opin Drug Saf. 2013 Jan;12(1):53-63. doi: 10.1517/14740338.2013.732569. Epub 2012 Oct 24.
Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are individually associated with a higher incidence of stroke as compared with the general population. Over the last two decades, an increase in prevalence of AF is seen in patients with CKD. While long-term anticoagulation with warfarin is well established to reduce the risk of thromboembolic event in patients with AF, its safety and efficacy has not been documented in patients with severe CKD.
In this review, the authors analyze the risk and benefit of long term anticoagulation across the spectrum of AF patients with CKD and explore the role of novel agents in this unique patient population. A Medline search of the English literature published between 1980 and 2012 was performed using the heading 'chronic kidney disease' combined with 'atrial fibrillation', 'hemodialysis', 'warfarin', 'anticoagulation' and 'new oral anticoagulants'.
Long-term anticoagulation with warfarin under strict monitoring appears to be the cornerstone of therapy in patients with CKD to prevent stroke. Further research is warranted to explore the safety and efficacy of newer anticoagulant agents in these high-risk patients in order to reduce the incidence of disabling stroke.
与普通人群相比，患有房颤（AF）和慢性肾脏病（CKD）的患者个体发生中风的风险更高。在过去的二十年中，CKD 患者中 AF 的患病率呈上升趋势。尽管长期使用华法林抗凝可有效降低 AF 患者血栓栓塞事件的风险，但在严重 CKD 患者中，其安全性和疗效尚未得到证实。
在这篇综述中，作者分析了 CKD 合并 AF 患者长期抗凝的风险和益处，并探讨了新型药物在这一特殊患者人群中的作用。通过使用“慢性肾脏病”和“房颤”、“血液透析”、“华法林”、“抗凝”和“新型口服抗凝剂”等标题，对 1980 年至 2012 年期间发表的英文文献进行了 Medline 搜索。
在严格监测下使用华法林进行长期抗凝似乎是预防中风的 CKD 患者的治疗基石。需要进一步研究以探索新型抗凝药物在这些高危患者中的安全性和疗效，以降低致残性中风的发生率。
