Department of Pharmacy, Manchester Royal Infirmary, Manchester, UK.
Department of Renal Medicine, Manchester Institute of Nephrology and Transplantation, Manchester, UK.
Br J Haematol. 2018 Jun;181(6):725-736. doi: 10.1111/bjh.15144. Epub 2018 Feb 22.
There is an increasing understanding of the risks from atrial fibrillation (AF) in the current era. In patients with end-stage renal disease (ESRD) on dialysis, the prevalence of AF is significantly higher compared to the general population and those with earlier stages of CKD. Although anticoagulation of these patients may seem appropriate, there is a lack of conclusive evidence that it provides the same protection from thromboembolic complications as it does in patients not on dialysis. In addition, the increased risk of bleeding in patients requiring dialysis makes the use of anticoagulants less favourable. This article aims to discuss the problem of AF in dialysis patients, summarise the current evidence around the use of oral anticoagulants for AF in ESRD and provide some practical suggestions on management of AF in the haemodialysis population.
目前，人们越来越了解心房颤动（AF）的风险。与普通人群以及慢性肾脏病（CKD）早期阶段的患者相比，终末期肾病（ESRD）透析患者的 AF 患病率明显更高。尽管这些患者进行抗凝治疗似乎是合理的，但没有确凿的证据表明它能像未透析患者那样提供同样的血栓栓塞并发症保护。此外，需要透析的患者出血风险增加，使得抗凝剂的使用不太有利。本文旨在讨论透析患者的 AF 问题，总结目前关于 ESRD 中 AF 使用口服抗凝剂的证据，并就血液透析人群中 AF 的管理提供一些实用建议。
