Koziolova N A, Polyanskaya E A, Kolegova I I
Perm State Medical University Named After Academician E.A. Wagner Health Ministry of Russian Federation, Perm, Russia.
Kardiologiia. 2017 Jan(1):76-85.
The review shows the prevalence of atrial fibrillation (AF) in patients with chronic kidney disease (CKD), depending on the severity of the disease. Patients with non-valvular AF and CKD have a significantly increased risk of both bleeding and thromboembolic complications, and death from all causes. Evaluation of the results of randomized clinical trials (RCTs), meta-analyzes of RCTs demonstrated the advantages of the new oral anticoagulants (NOAC), such as dabigatran, rivaroxaban, apixaban, compared with warfarin in reducing the risk of bleeding in patients with AF and CKD in predialysis stage. According to experimental and clinical studies, warfarin can promote renal vascular calcification. With the deterioration of filtration renal function during treatment with anticoagulants in patients with AF on the results of ROCKET AF study found that rivaroxaban is more preferable than warfarin in reducing the risk of stroke and systemic embolism without increasing the risk of bleeding. The absence of RCT data complicates the choice of anticoagulant therapy in patients with CKD on hemodialysis, although the NOAC approved by the Office of Quality Control Food and Drug US drugs (FDA) for the use of patients in this category. According to the instruction drugs rivaroxaban and apixaban are allowed to use in patients with end-stage CKD with creatinine clearance not less than 15 ml/min.
该综述显示了慢性肾脏病（CKD）患者中心房颤动（AF）的患病率，这取决于疾病的严重程度。非瓣膜性房颤和慢性肾脏病患者发生出血和血栓栓塞并发症以及全因死亡的风险显著增加。对随机临床试验（RCT）结果的评估、RCT的荟萃分析表明，新型口服抗凝药（NOAC），如达比加群、利伐沙班、阿哌沙班，与华法林相比，在降低透析前阶段房颤和慢性肾脏病患者出血风险方面具有优势。根据实验和临床研究，华法林可促进肾血管钙化。根据ROCKET AF研究结果，在房颤患者使用抗凝剂治疗期间，随着肾脏滤过功能的恶化，发现利伐沙班在降低中风和全身性栓塞风险方面比华法林更具优势，且不会增加出血风险。尽管美国食品药品监督管理局（FDA）质量控制办公室批准了NOAC用于此类患者，但缺乏RCT数据使血液透析的慢性肾脏病患者的抗凝治疗选择变得复杂。根据药品说明书，利伐沙班和阿哌沙班允许用于肌酐清除率不少于15 ml/min的终末期慢性肾脏病患者。
