Saheb Sharif-Askari Fatemeh, Syed Sulaiman Syed Azhar, Saheb Sharif-Askari Narjes
School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
, Dubai, 29005, United Arab Emirates.
Adv Exp Med Biol. 2017;906:101-114. doi: 10.1007/5584_2016_109.
Patients with chronic kidney disease (CKD) are at increased risk for both thrombotic events and bleeding. The early stages of CKD are mainly associated with prothrombotic tendency, whereas in its more advanced stages, beside the prothrombotic state, platelets can become dysfunctional due to uremic-related toxin exposure leading to an increased bleeding tendency. Patients with CKD usually require anticoagulation therapy for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of anticoagulant-induced bleeding. Treatment of patients with CKD should be based on evidence from randomized clinical trials, but usually CKD patients are excluded from these trials. In the past, unfractionated heparins were the anticoagulant of choice for patients with CKD because of its independence of kidney elimination. However, currently low-molecular-weight heparins have largely replaced the use of unfractionated heparins owing to fewer incidences of heparin-induced thrombocytopenia and bleeding. We undertook this review in order to explain the practical considerations for the management of anticoagulation in these high risk population.
慢性肾脏病（CKD）患者发生血栓事件和出血的风险均有所增加。CKD的早期阶段主要与血栓形成倾向相关，而在其更晚期阶段，除了血栓形成状态外，由于接触尿毒症相关毒素，血小板可能会功能失调，导致出血倾向增加。CKD患者通常需要抗凝治疗来治疗或预防血栓栓塞性疾病。然而，这种益处很容易被抗凝剂诱导的出血风险所抵消。CKD患者的治疗应基于随机临床试验的证据，但CKD患者通常被排除在这些试验之外。过去，普通肝素因其不依赖肾脏清除而成为CKD患者的首选抗凝剂。然而，目前低分子量肝素已在很大程度上取代了普通肝素的使用，因为肝素诱导的血小板减少症和出血的发生率较低。我们进行这项综述是为了解释在这些高危人群中进行抗凝管理的实际注意事项。
