Department of Pharmacy, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Department of Haematology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Br J Haematol. 2018 Oct;183(2):170-184. doi: 10.1111/bjh.15564. Epub 2018 Sep 5.
Increasing use of direct oral anticoagulants (DOACs) has made management of non-valvular atrial fibrillation and venous thromboembolism easier in most patients. But the presence of co-existing renal impairment could render the use of DOACs problematic because all of these drugs have varying degrees of renal excretion. In this paper we address misconceptions about the safety and efficacy of DOACs in moderate-severe renal impairment by presenting a summary of the literature from phase III trials and real-world studies. It also addresses the important consideration of correct estimate of renal function for DOAC dosing. It is hoped that the review will serve as a valuable resource for clinicians involved in anticoagulation decision-making in patients with renal impairment to guide the choice of most suitable agent. Accurate dosing is of particular relevance as registry data suggests it is done inconsistently and may be resulting in avoidable thromboembolic and bleeding events.
直接口服抗凝剂（DOACs）的应用日益增多，使大多数患者的非瓣膜性心房颤动和静脉血栓栓塞症的治疗更加容易。但共存的肾功能损害可能会使 DOAC 的使用变得成问题，因为所有这些药物的肾排泄都有不同程度的影响。在本文中，我们通过总结 III 期临床试验和真实世界研究的文献，阐述了关于中度至重度肾功能损害患者中 DOAC 安全性和疗效的误解。还讨论了正确估计 DOAC 剂量的肾功能的重要性。希望该综述能为参与肾功能损害患者抗凝治疗决策的临床医生提供有价值的资源，以指导选择最合适的药物。准确的剂量尤其重要，因为登记数据表明剂量的使用不一致，可能导致可避免的血栓栓塞和出血事件。
