口服抗凝剂在非瓣膜性房颤伴慢性肾功能不全患者中的应用进展

Progress in the Application of Oral Anticoagulants in Patients with Non⁃valvular Atrial Fibrillation and Chronic Renal Insufficiency

口服抗凝剂可有效降低房颤患者的卒中风险,但房颤伴慢性肾功能不全患者的卒中和出血风险却明显升高,给抗凝治疗带来困难。非维生素K拮抗剂类口服抗凝剂疗效和安全性不劣于传统的抗凝剂华法林,无需定期监测国际标准化比值,患者依从性更好。然而,非维生素K拮抗剂类口服抗凝剂均不同程度地通过肾脏代谢,其在非瓣膜性房颤伴慢性肾功能不全患者中的应用尚存在争议。本文对非瓣膜性房颤伴慢性肾功能不全患者口服抗凝剂的应用进展进行综述,以期为临床实践提供参考。

Oral anticoagulants can effectively reduce the risk of stroke in patients with atrial fibrillation. However, patients with atrial fibrillation and chronic renal insufficiency have an increased risk in both stroke and bleeding, making anticoagulant therapy challenging. Compared with traditional anticoagulant warfarin, non-vitamin K antagonist oral anticoagulants are non-inferior to warfarin in efficacy and safety. They don’t require routine monitoring of the international normalized ratio and have better patient compliance. However, all the non-vitamin K antagonist oral anticoagulants are partially metabolized through kidneys to a varying degree, and thus their administration in patients with atrial fibrillation and chronic renal insufficiency is controversial. This review summarizes the administration of oral anticoagulants in these patients to guide clinical practice.