Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.
Department of Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada.
Int J Environ Res Public Health. 2022 Jan 27;19(3):1436. doi: 10.3390/ijerph19031436.
The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of orally administered drugs to prevent thromboembolic events in patients with CKD who require anticoagulation: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Although VKAs remain the first-line treatment in patients with advanced CKD, treatment with VKAs is challenging due to difficulties in maintaining the appropriate anticoagulation level, tendency to accelerate vascular calcification and faster progression of CKD in patients treated with VKAs. On the other hand, the pleiotropic effect of DOACs, including vascular protection and anti-inflammatory properties along with comparable efficacy and safety of treatment with DOACs, compared to VKAs observed in preliminary reports encourages the use of DOACs in patients with CKD. This review summarizes the available data on the efficacy and safety of DOACs in patients with CKD and provides recommendations regarding the choice of the optimal drug and dosage depending on the CKD stage.
慢性肾脏病（CKD）的患病率由于人口老龄化和高血压、动脉硬化和肥胖等危险因素的增加而不断上升。肾功能受损会增加出血和血栓形成的风险。对于需要抗凝治疗的 CKD 患者，有两组口服药物可预防血栓栓塞事件：维生素 K 拮抗剂（VKA）和直接口服抗凝剂（DOAC）。尽管 VKA 仍然是晚期 CKD 患者的一线治疗药物，但由于难以维持适当的抗凝水平、VKA 治疗患者血管钙化倾向加速以及 CKD 进展更快，VKA 的治疗具有挑战性。另一方面，DOAC 的多效作用，包括血管保护和抗炎特性，以及与 VKA 相比，DOAC 治疗的疗效和安全性相当，这在初步报告中得到了证实，这鼓励了在 CKD 患者中使用 DOAC。这篇综述总结了现有关于 DOAC 在 CKD 患者中的疗效和安全性的数据，并根据 CKD 分期提供了关于选择最佳药物和剂量的建议。
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