Cortese Francesca, Scicchitano Pietro, Gesualdo Michele, Ricci Gabriella, Carbonara Santa, Franchini Carlo, Pia Schiavone Brigida Immacolata, Corbo Filomena, Ciccone Marco Matteo
Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Policlinico, Bari, Italy.
Department of Pharmacy, University of Bari, Policlinico, Bari, Italy.
Curr Med Chem. 2017 Nov 17;24(34):3813-3827. doi: 10.2174/0929867324666170818112904.
Thromboembolic events, principally stroke, represent one of the leading causes of morbidity and mortality among subjects with atrial fibrillation. Chronic kidney disease determines a further increase of thromboembolic events, bleeding and mortality and complicates the pharmacological management of patients with atrial fibrillation, mainly due to the side effects of antiarrhythmic and anticoagulant drugs with renal excretion. Apixaban is a new oral anticoagulant characterized by good bioavailability and renal elimination accounting for only 25%, showing a safety profile and effectiveness in patients with renal impairment.
In this manuscript, we reviewed literature data on the use of apixaban in the management of non-valvular atrial fibrillation in patients with renal failure, in order to clarify an often-debated topic in clinical practice.
A PubMed search was performed on the terms atrial fibrillation, apixaban and renal failure with the aim of identifying relevant manuscripts, large randomized clinical trials, meta-analyses, and current guidelines.
Literature data show that apixaban could represent an interesting alternative to warfarin and other selective antagonists of coagulation factors in patients with impaired renal function. About the risk of major bleeding, apixaban appears to be safer than warfarin in the presence of any degree of renal failure.
Apixaban show to be an effective anticoagulant in patients with atrial fibrillation, even superior to warfarin in reducing the risk of stroke and systemic embolism regardless of the presence of renal insufficiency. Moreover, Food and Drug Administration allows the use of apixaban in patients with end stage renal disease on hemodialysis.
血栓栓塞事件，主要是中风，是心房颤动患者发病和死亡的主要原因之一。慢性肾病会进一步增加血栓栓塞事件、出血和死亡风险，并使心房颤动患者的药物治疗复杂化，主要是由于经肾脏排泄的抗心律失常和抗凝药物的副作用。阿哌沙班是一种新型口服抗凝剂，具有良好的生物利用度，且经肾脏排泄的比例仅为25%，在肾功能不全患者中显示出安全性和有效性。
在本手稿中，我们回顾了有关阿哌沙班用于肾衰竭患者非瓣膜性心房颤动管理的文献数据，以阐明临床实践中一个经常争论的话题。
在PubMed上以心房颤动、阿哌沙班和肾衰竭为关键词进行检索，旨在识别相关手稿、大型随机临床试验以及当前指南。
文献数据表明，在肾功能受损的患者中，阿哌沙班可能是华法林和其他凝血因子选择性拮抗剂的一个有趣替代药物。关于大出血风险，在任何程度的肾衰竭情况下，阿哌沙班似乎比华法林更安全。
阿哌沙班在心房颤动患者中显示出是一种有效的抗凝剂，在降低中风和全身性栓塞风险方面甚至优于华法林，无论是否存在肾功能不全。此外，美国食品药品监督管理局允许在接受血液透析的终末期肾病患者中使用阿哌沙班。
