心房颤动合并慢性肾脏疾病患者口服抗凝的治疗策略

Oral anticoagulation therapy in patients with atrial fibrillation and concomitant chronic kidney disease

口服抗凝药物(oral anticoagulants,OACs)在预防心房颤动(atrial fibrillation,AF)导致的卒中和全身栓塞性疾病中发挥着重要作用,被广泛用于缺血中、高危的AF患者。AF大多同时合并慢性肾脏疾病(chronic kidney disease,CKD)。严重肾功能不全是AF患者发生卒中的独立危险因素,同时肾功能不全对OACs的体内处置也会产生不同程度的影响。因此,临床上对AF合并CKD患者的口服抗凝治疗方案需要更加谨慎。本文拟综述国内已批准的OACs在AF合并CKD患者的药代动力学变化及安全有效性,为指导临床上OACs的合理使用提供依据。

Oral anticoagulants(OACs) have been widely used in patients with atrial fibrillation(AF) who have moderate or high risk of thromboembolism to reduce stroke and systemic embolism.AF and chronic kidney disease(CKD) frequently coexist.Stage 3 CKD is an independent risk factor for stroke in patients with AF.Besides,all OACs undergo renal clearance to varying degrees,and hence dosing,efficacy,and safety require special consideration in patients with CKD.This review is intended to explore the pharmacokinetic changes and safety and efficacy of approved OACs in patients with AF and CKD.Based on this,the OACs selection scheme and dose recommendation for this population are provided,in order to provide guidance for the rational use of OACs.