Di Lullo Luca, Magnocavallo Michele, Vetta Giampaolo, Lavalle Carlo, Barbera Vincenzo, Ronco Claudio, Paoletti Ernesto, Ravera Maura, Fusaro Maria, Russo Domenico, De Pascalis Antonio, Bellasi Antonio
UOC Nefrologia e Dialisi, Ospedale Parodi-Delfino, 00034 Colleferro, Italy.
Dipartimento di Scienza Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Universitario Umberto I, Sapienza Università di Rome, 00161 Roma, Italy.
G Ital Nefrol. 2022 Apr 21;39(2):2022-vol2.
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related and share several risk factors (i.e. hypertension, diabetes mellitus, congestive heart failure). As consequence, AF is very common among CKD patients, especially in those with end stage renal disease (ESRD). Moreover, patients with AF and advanced kidney disease have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. The adequate long-term oral anticoagulation in this subgroup of patients represents a major challenging issue faced by physicians in clinical practice. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD while vitamin K antagonists (VKAs) are characterized by a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
心房颤动（AF）与慢性肾脏病（CKD）密切相关，且有多种共同的危险因素（如高血压、糖尿病、充血性心力衰竭）。因此，AF在CKD患者中非常常见，尤其是在终末期肾病（ESRD）患者中。此外，与肾功能正常的患者相比，AF合并晚期肾病的患者死亡率更高，这是由于中风发生率增加以及出血风险意外升高所致。在这一亚组患者中进行充分的长期口服抗凝治疗是临床医生在实践中面临的一个重大挑战。目前，ESRD患者禁用直接口服抗凝剂（DOACs），而维生素K拮抗剂（VKAs）的治疗窗较窄，会增加组织钙化，且风险/效益比不佳，预防中风的效果较低，大出血风险增加。本综述的目的是阐明DOAC治疗在CKD患者，尤其是ESRD患者中的应用。
