Department of Medicine (Nephrology), McMaster University, Hamilton, Ontario, Canada.
Postgrad Med. 2012 Nov;124(6):17-25. doi: 10.3810/pgm.2012.11.2609.
Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with an increased risk for thromboembolic stroke. Anticoagulant therapy has been shown to reduce the risk for ischemic stroke in patients with AF; however, these studies have excluded patients with end-stage renal disease (ESRD). This review examines the relationships between ESRD, AF, and the use of anticoagulants to prevent ischemic stroke. Medline and Embase were used to identify relevant articles. Identified review articles and their references were searched. The prevalence of AF in patients with ESRD is higher than that in the general population; ESRD appears to be an independent risk factor for AF. The presence of AF in patients with ESRD increases the risk for stroke, although this effect is less pronounced when compared with the general population. The presence of ESRD confers an increased risk for bleeding; warfarin appears to enhance this risk. Observational data suggest that warfarin increases the rate of hemorrhagic stroke in patients with ESRD, but are unclear on its utility in reducing ischemic stroke. In addition to increasing the risk for bleeding, warfarin may also promote vascular calcification in this population. Currently, there are no oral anticoagulants other than warfarin that are approved for use in patients with ESRD. Recent guidelines suggest that warfarin only be used for secondary prevention in patients with ESRD and AF. Randomized controlled trials are needed to clarify the role of warfarin or other anticoagulants in preventing stroke in patients with ESRD and AF.
心房颤动（AF）是一种常见的心律失常，与血栓栓塞性卒中风险增加相关。抗凝治疗已被证明可降低 AF 患者缺血性卒中的风险；然而，这些研究排除了终末期肾病（ESRD）患者。本综述探讨了 ESRD、AF 和使用抗凝剂预防缺血性卒中之间的关系。使用 Medline 和 Embase 确定相关文章。搜索了确定的综述文章及其参考文献。ESRD 患者中 AF 的患病率高于普通人群；ESRD 似乎是 AF 的独立危险因素。ESRD 患者中 AF 的存在增加了卒中风险，尽管与普通人群相比，这种影响不太明显。ESRD 的存在增加了出血的风险；华法林似乎增加了这种风险。观察性数据表明，华法林会增加 ESRD 患者出血性卒中的发生率，但对于其在降低缺血性卒中方面的作用尚不清楚。除了增加出血风险外，华法林在该人群中还可能促进血管钙化。目前，除了华法林以外，没有其他口服抗凝剂被批准用于 ESRD 患者。最近的指南建议仅将华法林用于 ESRD 和 AF 患者的二级预防。需要进行随机对照试验来阐明华法林或其他抗凝剂在预防 ESRD 和 AF 患者卒中方面的作用。
