Mahmood Maria, Lip Gregory Y H
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Rev Esp Cardiol (Engl Ed). 2018 Oct;71(10):847-855. doi: 10.1016/j.rec.2018.05.015. Epub 2018 Jun 27.
Both atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, especially with increasing age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between both AF and CKD seems to be bidirectional: CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of stroke, mortality, cardiac events, and bleeding. Stroke prevention requires use of oral anticoagulants, which are either vitamin K antagonists (eg, warfarin), or the nonvitamin K antagonist oral anticoagulants (NOACs). While NOACs have been shown to be effective in mild-to-moderate renal dysfunction, there are a paucity of data regarding NOACs in severe and end-stage renal dysfunction. This review first discusses the evidence for NOACs in CKD. Second, we summarize the current knowledge regarding the efficacy and safety of NOACs to prevent AF-related stroke and systemic embolism in severe and end-stage renal disease.
心房颤动（AF）和慢性肾脏病（CKD）都极为常见，尤其是随着年龄增长以及合并诸如高血压、糖尿病、心力衰竭和血管疾病等其他疾病时。AF与CKD之间的关系似乎是双向的：CKD易引发AF，而AF的发作似乎会导致CKD病情进展。预防中风是AF管理的基石，患有CKD的AF患者发生中风、死亡、心脏事件和出血的风险更高。预防中风需要使用口服抗凝剂，即维生素K拮抗剂（如华法林）或非维生素K拮抗剂口服抗凝剂（NOACs）。虽然已证明NOACs在轻至中度肾功能不全患者中有效，但关于NOACs在重度和终末期肾功能不全患者中的数据却很少。本综述首先讨论CKD患者使用NOACs的证据。其次，我们总结了目前关于NOACs在重度和终末期肾病中预防AF相关中风和全身性栓塞的疗效和安全性的知识。
