Features of Modern Anticoagulant Therapy in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Racionalʹnaâ Farmakoterapiâ v Kardiologii

A. A. Sokolova¹  I. S. Daabul¹  D. A. Napalkov¹ 

[1] I.M. Sechenov First Moscow State Medical University. Trubetskaya ul. 8-2, Moscow, 119991 Russia;

关键词: nonvalvular atrial fibrillation;    chronic kidney disease;    warfarin;    direct oral anticoagulants;    dabigatran;    rivaroxaban;    apixaban;    renal arteries atherosclerosis;   

DOI  :  10.20996/1819-6446-2016-12-5-595-602

来源: DOAJ

【 摘 要 】

Prevalence of atrial fibrillation (AF) in population is very high and continues to grow. According to the existing statistics its prevalence reaches about 2% so it is twice more, than it was considered in the last decade. Prevalence of AF among patients with chronic kidney disease (CKD) varies from 11 to 22% (according to other data – from 15 to 20%) and increases with age, considerably surpassing that in the general population among all age groups. Vast majority of patients with AF need in treatment with anticoagulants to prevent an ischemic stroke and systemic thromboembolisms. However, in case of combination AF and CKD, in addition to increase in frequency of strokes and the thromboembolic events, also the frequency of major bleedings significantly increases that considerably complicates the choice of adequate anticoagulant therapy in such situation. Many years the vitamin K antagonists were the only representatives of a class of anticoagulants for long-term therapy in patients with AF. Their well-known deficiencies (a narrow therapeutic window, need of frequent laboratory control, numerous drug-drug and dietary interactions, unpredictability of a pharmacodynamics and pharmacokinetics at certain patients) promoted search of new medicines, more convenient in use. Direct oral anticoagulants were easier to use, and by results of the main studies didn't yield or exceeded warfarin concerning balance of efficiency and safety. However, they were not specially studied in patients with the reduced kidney function. Features of modern anticoagulant therapy in patients with the nonvalvular AF and CKD are considered in the review. The possibility of the safest use of anticoagulants for patients with decreased creatinine clearance is analyzed.

【 授权许可】

Unknown