Merella Pierluigi, Casu Gavino, Mazzone Patrizio, Lorenzoni Giovanni, D'Angelo Giuseppe, Genovesi Simonetta
Unità Operativa di Cardiologia, Ospedale San Francesco, Nuoro, Italy.
CardiacPacing Unit, IRCCS Ospedale San Raffaele, Milano, Italy.
G Ital Nefrol. 2019 Feb;36(1).
Non-valvular atrial fibrillation (AF) is the most frequent arrhythmia in the general population and its prevalence increases with age. The prevalence and incidence of AF is high in patients with chronic kidney failure (CKD). The most important complication associated with AF, both in the general population and in that with CKD, is thromboembolic stroke. For this reason, in patients with AF, the Guidelines indicate oral anticoagulant therapy (OAT) with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for thromboembolic risk prevention. Patients with severe CKD and, in particular, with end stage renal disease (ESRD) undergoing renal replacement therapy, often have both a high thromboembolic and hemorrhagic risk and therefore present both an indication and a contraindication to OAT. In addition, patients with severe or ESRD were excluded from trials that showed the efficacy of different antithrombotic drugs in patients with AF. Thus there is no evidence of the effectiveness of OAT in this population. This review deals with the issues related to OAT in patients with severe or end stage CKD and the possible use of percutaneous closure of the left auricula (LAAO), recently proposed as an alternative in patients with an absolute contraindication of OAT in this population.
非瓣膜性心房颤动（AF）是普通人群中最常见的心律失常，其患病率随年龄增长而增加。慢性肾衰竭（CKD）患者中AF的患病率和发病率较高。在普通人群和CKD患者中，与AF相关的最重要并发症是血栓栓塞性中风。因此，对于AF患者，指南指出使用维生素K拮抗剂（VKAs）或直接口服抗凝剂（DOACs）进行口服抗凝治疗（OAT）以预防血栓栓塞风险。患有严重CKD，特别是接受肾脏替代治疗的终末期肾病（ESRD）患者，通常具有较高的血栓栓塞和出血风险，因此既是OAT的适应证又是禁忌证。此外，严重CKD或ESRD患者被排除在显示不同抗血栓药物对AF患者有效性的试验之外。因此，没有证据表明OAT在该人群中有效。本综述探讨了严重或终末期CKD患者中与OAT相关的问题，以及最近提议作为该人群中OAT绝对禁忌患者替代方法的经皮左心耳封堵术（LAAO）的可能应用。
