Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation JACC Review Topic of the Week

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Review

Kumar, Shankar^1,2  Lim, Emma²  Covic, Adrian³  Verhamme, Peter⁴  Gale, Chris P.⁵  Camm, A. John⁷  Goldsmith, David^3,6,7 

[1] UCL, Ctr Med Imaging, London, England

[2] Univ Coll London Hosp NHS Fdn Trust, Imaging Dept, London, England

[3] Univ Med & Pharm Gr T Popa, Dept Nephrol, Iasi, Romania

[4] Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium

[5] Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, W Yorkshire, England

[6] St Georges Univ London, Mol & Clin Sci Res Inst, London, England

[7] Guys & St Thomas Hosp NHS Fdn Trust, Renal & Transplantat Dept, London SE1 9RT, England

关键词: atrial fibrillation;    chronic kidney disease;    direct oral anticoagulant;    hemorrhage;    stroke;    vitamin K antagonist;    warfarin;   

DOI  :  10.1016/j.jacc.2019.08.1031

来源: Elsevier

【 摘 要 】

Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist as they share multiple risk factors, including hypertension, diabetes mellitus, and coronary artery disease. Although there is irrefutable evidence supporting anticoagulation in AF in the general population, these data may not be transferable to the setting of advanced CKD, where the decision to commence anticoagulation poses a conundrum. In this cohort, there is a progressively increased risk of both ischemic stroke and hemorrhage as renal function declines, complicating the decision to initiate anticoagulation. No definitive clinical guidelines derived from randomized controlled trials exist to aid clinical decision-making, and the findings from observational studies are conflicting. In this review, the authors outline the pathophysiological mechanisms at play and summarize the limited existing data related to anticoagulation in those with concomitant CKD and AF. Finally, the authors suggest how to approach the decision of whether and how to use oral anticoagulation in these patients. (C) 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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