Liao Jo-Nan, Kuo Ling, Liu Chih-Min, Chen Shih-Ann, Chao Tze-Fan
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan.
Eur Heart J Suppl. 2022 Feb 14;24(Suppl A):A11-A18. doi: 10.1093/eurheartj/suab154. eCollection 2022 Feb.
Advanced chronic kidney disease (CKD) or chronic liver disease (CLD) is frequent in patients with atrial fibrillation (AF) because of their common risk factors. Chronic kidney disease and CLD superimposed on AF are associated with increased risks of thrombosis and bleeding, which further complicates the use of oral anticoagulants (OACs). Because currently approved non-vitamin K antagonist oral anticoagulants (NOACs) undergo certain degrees of metabolism and clearance in the liver and kidney, increased exposure to medications and risk of bleeding are major concerns with the use of NOACs in patients with advanced CKD and CLD. Besides, these patients were mostly excluded from landmark trials of NOACs and related cohort studies are also limited. Therefore, the optimal strategy for the use of NOACs in this population remains unclear. This review would go through current evidence regarding the safety and efficacy of NOACs in AF patients with advanced CKD and CLD and provide a comprehensive discussion for clinical practices.
由于存在共同的风险因素，晚期慢性肾脏病（CKD）或慢性肝病（CLD）在心房颤动（AF）患者中很常见。慢性肾脏病和CLD叠加在AF上与血栓形成和出血风险增加相关，这进一步使口服抗凝药（OAC）的使用复杂化。由于目前已批准的非维生素K拮抗剂口服抗凝药（NOAC）在肝脏和肾脏中会经历一定程度的代谢和清除，因此在晚期CKD和CLD患者中使用NOAC时，药物暴露增加和出血风险是主要关注点。此外，这些患者大多被排除在NOAC的标志性试验之外，相关队列研究也很有限。因此，在该人群中使用NOAC的最佳策略仍不明确。本综述将梳理关于NOAC在晚期CKD和CLD的AF患者中的安全性和有效性的现有证据，并为临床实践提供全面讨论。
