Dzhioeva O N, Orlova A A, Rogozhkina E A, Drapkina O M
National Research Center for Therapy and Preventive Medicine.
Yevdokimov Moscow State University of Medicine and Dentistry.
Ter Arkh. 2022 Jan 15;94(1):129-134. doi: 10.26442/00403660.2022.01.201358.
The article is an opinion on the problem of venous thromboembolic (VTE) complications in patients with chronic kidney disease (CKD), which is significant and urgent for Russia. Signs of CKD are noted in more than 1/3 of patients with chronic heart failure; a decrease in kidney function is observed in 36% of people over the age of 60, in people of working age, a decrease in function is noted in 16% of cases, and in the presence of cardiovascular diseases increases to 26%. Clinical research data convincingly show that CKD is an independent risk factor for the development of VTE complications. The last decade has given us the opportunity to observe a kind of "revolution" in VTE therapy, which is associated with the appearance on the market of direct oral anticoagulants, including inhibitors of factor IIa (thrombin) and factor Xa. These drugs are approved by the Food and Drug Administration for the treatment of acute thromboembolism. Nevertheless, patients with severe CKD (estimated glomerular filtration rate 30 ml/min) are still limited to the use of unfractionated heparin and vitamin K antagonists, as there is insufficient data to support the use of direct oral anticoagulants in this population.
本文是对慢性肾脏病(CKD)患者静脉血栓栓塞(VTE)并发症问题的一种观点,这对俄罗斯来说既重要又紧迫。超过1/3的慢性心力衰竭患者存在CKD迹象;60岁以上人群中36%的人肾功能下降,在职年龄人群中16%的病例出现功能下降,而在患有心血管疾病的人群中这一比例增至26%。临床研究数据有力地表明,CKD是VTE并发症发生的独立危险因素。过去十年让我们有机会观察到VTE治疗领域的一种“革命”,这与直接口服抗凝剂在市场上的出现有关,包括凝血因子IIa(凝血酶)和凝血因子Xa抑制剂。这些药物已获美国食品药品监督管理局批准用于治疗急性血栓栓塞。然而,重度CKD患者(估计肾小球滤过率<30 ml/min)仍仅限于使用普通肝素和维生素K拮抗剂,因为尚无足够数据支持在该人群中使用直接口服抗凝剂。