Chunduri Svetha, Folstad Jon E, Vachharajani Tushar J
Division of Nephrology, Salisbury VA Health Care System (SVAHCS), Salisbury, North Carolina, USA.
Clinical Pharmacy Services, Salisbury VA Health Care System (SVAHCS), Salisbury, North Carolina, USA.
Hemodial Int. 2017 Oct;21(4):453-471. doi: 10.1111/hdi.12571. Epub 2017 May 23.
The delicate balance of risk vs. benefit of using antiplatelet and antithrombotic agents in the general population is well established. The decision to use these agents in the end stage renal disease (ESRD) population remains complex and difficult. The concomitant association of a prothombotic state with high risk of bleeding in the ESRD population requires individualization and careful clinical judgment before implementing such therapy. There remains a paucity of clinical trials and lack of substantial evidence in literature for safe and effective use of antithrombotic drugs in patients with advanced chronic kidney disease. The current review summarizes the pros and cons of using antiplatelet and antithrombotic agents in primary and secondary prevention of cardiovascular events, evaluate the risks with routine use of anticoagulation for cerebrovascular stroke prevention with nonvalvular atrial fibrillation and role of newer oral anticoagulants as alternate agents in the dialysis population.
在普通人群中使用抗血小板和抗血栓药物时，风险与获益之间的微妙平衡已得到充分确立。在终末期肾病（ESRD）人群中使用这些药物的决策仍然复杂且困难。ESRD人群中血栓形成倾向与高出血风险并存，这需要在实施此类治疗前进行个体化和谨慎的临床判断。对于晚期慢性肾病患者安全有效地使用抗血栓药物，仍然缺乏临床试验且文献中缺乏充分证据。本综述总结了在心血管事件一级和二级预防中使用抗血小板和抗血栓药物的利弊，评估了常规使用抗凝药物预防非瓣膜性心房颤动所致脑血管卒中的风险，以及新型口服抗凝剂在透析人群中作为替代药物的作用。
