University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom.
University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom; Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy.
J Am Coll Cardiol. 2016 Sep 27;68(13):1452-1464. doi: 10.1016/j.jacc.2016.06.057.
A bidirectional relationship exists between atrial fibrillation (AF) and chronic renal disease. Patients with AF have a higher incidence of renal dysfunction, and the latter predisposes to incident AF. The coexistence of both conditions results in a higher risk for thromboembolic-related adverse events but a paradoxical increased hemorrhagic risk. Oral anticoagulants (both vitamin K antagonists [VKAs] and non-VKA oral anticoagulants [NOACs]) have been demonstrated to be effective in mild to moderate renal dysfunction. Patients with severe renal impairment were excluded from the non-VKA oral anticoagulant trials, so limited data are available. In end-stage renal failure, the net clinical benefit of VKAs in dialysis-dependent patients remains uncertain, although some evidence suggests that such patients may do well with high-quality anticoagulation control. Risk stratification and careful follow-up of such patients are necessary to ensure a net clinical benefit from thromboprophylaxis.
心房颤动（AF）与慢性肾脏病之间存在双向关系。患有 AF 的患者肾功能障碍的发生率更高，而后者易发生 AF。两种病症同时存在会增加与血栓栓塞相关的不良事件风险，但却出现出血风险增加的矛盾现象。已证实口服抗凝剂（维生素 K 拮抗剂[VKA]和非 VKA 口服抗凝剂[NOAC]）在轻度至中度肾功能障碍中有效。非 VKA 口服抗凝剂试验排除了严重肾功能损害的患者，因此可用数据有限。在终末期肾衰竭中，依赖透析的患者应用 VKA 的净临床获益仍不确定，尽管有一些证据表明此类患者可能通过高质量抗凝控制取得良好效果。需要对这些患者进行风险分层和仔细随访，以确保血栓预防带来净临床获益。
