新型口服抗凝药在慢性肾病患者中的应用

基础医学与临床 ›› 2020, Vol. 40 ›› Issue (8): 1103-1108.

新型口服抗凝药在慢性肾病患者中的应用

汪秀衡³, 吴洁², 胡恒境^1,2*

1.南华大学基础医学博士后流动站;
2.南华大学附属第一医院心内科;
3.南华大学附属第一医院核医学科,湖南衡阳 421000

收稿日期:2019-07-04 修回日期:2019-12-06 出版日期:2020-08-05 发布日期:2020-07-29
通讯作者: ^*bestmanhhj@hotmail.com
基金资助:
国家自然科学基金(81700306);湖南省自然科学基金(2018JJ3469);中国博士后科学基金(2017M622588);湖南省卫生健康委(C2019115)

Application of new orally anticoagulants in patients with chronic kidney disease

WANG Xiu-heng³, WU Jie², HU Heng-jing^1,2*

1. Postdoctoral Research Station of Basic Medicine, University of South China;
2. Department of Cardiology Lab, the First Affiliated Hospital of University of South China;
3. Department of Nuclear Medicine Lab, the First Affiliated Hospital of University of South China, Hengyang 421000, China

Received:2019-07-04 Revised:2019-12-06 Online:2020-08-05 Published:2020-07-29
Contact: ^*bestmanhhj@hotmail.com

摘要/Abstract

摘要： 新型口服抗凝剂(NOACs)是一种新研发的凝血因子抑制剂,在各种血栓事件及缺血性心血管事件中发挥着重要的作用,但其在慢性肾病(CKD)3~5期患者中的使用仍存在争议。对不同分期CKD患者推荐使用NOACs、监测评价NOACs所致抗凝相关肾病及NOACs临床应用。

关键词: 慢性肾病, 新型口服抗凝药, 栓塞

Abstract: Novel oral anticoagulants (NOVACs) as blood coagulation factor inhibitors have exhibited pivotal role in thromboembolic event and ischemic cardiovascular disease. Nevertheless, it's application in chronic kidney disease (CKD) patients of stage 3-5 remains controversial. This paper reviewed currently recommended usage of NOACs in CKD patients of stage 3-5 in the evaluation of anticoagulation related nephropathy, clinical monitoring and assessment of NOACs.

Key words: chronic kidney disease, new oral anticoagulant, embolization

中图分类号:

汪秀衡, 吴洁, 胡恒境. 新型口服抗凝药在慢性肾病患者中的应用[J]. 基础医学与临床, 2020, 40(8): 1103-1108.

WANG Xiu-heng, WU Jie, HU Heng-jing. Application of new orally anticoagulants in patients with chronic kidney disease[J]. Basic & Clinical Medicine, 2020, 40(8): 1103-1108.

参考文献

[1] Bohula EA, Giugliano RP, Ruff CT, et al. Impact of renal function on outcomes with edoxaban in the ENGAGE AF-TIMI 48 trial[J]. Circulation, 2016, 134:24-36.
[2] Hijazi Z, Hohnloser SH, Andersson U, et al. Efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation in relation to renal function over time: insights from the ARISTOTLE randomized clinical trial[J]. JAMA Cardiol, 2016, 1:451-460.
[3] Mega JL, Simon T. Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments[J]. Lancet, 2015, 386:281-291.
[4] Limdi NA, Beasley TM, Baird MF, et al. Kidney function influences warfarin responsiveness and hemorrhagic complications[J]. J Am Soc Nephrol, 2009, 20:912-921.
[5] Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation[J]. N Engl J Med, 2009,361:1139-1151.
[6] Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J]. N Engl J Med, 2011,365:883-891.
[7] Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation[J]. N Engl J Med, 2011,365:981-992.
[8] Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation[J]. N Engl J Med, 2013,369:2093-2104.
[9] Nielsen PB, Lane DA, Rasmussen LH, et al. Renal function and non-vitamin K oral anticoagulants in comparison with warfarin on safety and efficacy outcomes in atrial fibrillation patients: a systemic review and meta-regression analysis[J]. Clin Res Cardiol, 2015, 104:418-429.
[10] Fordyce CB, Hellkamp AS, Lokhnygina Y, et al. On-treatment outcomes in patients with worsening renal function with rivaroxaban compared with warfarin: insights from ROCKET AF[J]. Circulation, 2016, 134:37-47.
[11] Heidbuchel H, Verhamme P, Alings M, et al. Updated european heart rhythm association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: executive summary[J]. Eur Heart J, 2017, 38:2137-2149.
[12] Del-Carpio Munoz F, Gharacholou SM, Munger TM, et al. Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation[J]. Am J Cardiol, 2016, 117:69-75.
[13] Chan YH, Kuo CT, Yeh YH, et al. Thromboembolic, bleeding, and mortality risks of rivaroxaban and dabiga-tran in asians with nonvalvular atrial fibrillation[J]. J Am Coll Cardiol, 2016, 68:1389-1401.
[14] Ha JT, Neuen BL, Cheng LP, et al. Benefits and harms of oral anticoagulant therapy in chronic kidney disease: a systematic review and meta-analysis[J]. Ann Intern Med, 2019, 171:181-189.
[15] Steffel J, Verhamme P, Potpara TS, et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.[J]. Eur Heart J, 2018, 39:1330-1393.
[16] Chiang CE, Okumura K, Zhang S, et al. 2017 consensus of the asia pacific heart rhythm society on stroke prevention in atrial fibrillation[J]. J Arrhythm, 2017, 33:345-367.
[17] Zbigniew K, Hubert S, Andrzej J, et al. Safety of new oral anticoagulants for patients with chronic kidney disease[J]. Curr Pharm Des, 2018, 24:4505-4510.
[18] Yoon CY, Noh J, Jhee JH, et al. Warfarin use in patients with atrial fibrillation undergoing hemodialysis: a nationwide population-based study[J]. Stroke, 2017, 48:2472-2479.
[19] Shah M, Avgil Tsadok M, Jackevicius CA, et al. Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis[J]. Circulation, 2014, 129:1196-1203.
[20] Chan KE, Edelman ER, Wenger JB, et al. Dabigatran and rivaroxaban use in atrial fibrillation patients on hemodialysis[J]. Circulation, 2015, 131:972-979.
[21] Kalaitzidis RG, Duni A, Liapis G, et al. Anticoagulant-related nephropathy: a case report and review of the literature of an increasingly recognized entity[J]. Int Urol Nephrol, 2017, 49:1401-1407.
[22] Berger R, Salhanick SD, Chase M, et al. Hemorrhagic complications in emergency department patients who are receiving dabigatran compared with warfarin[J]. Ann Emerg Med, 2013, 61:475-479.
[23] Chan YH, Yeh YH, See LC, et al. Acute kidney injury in asians with atrial fibrillation treated with dabigatran or warfarin[J]. J Am Coll Cardiol, 2016, 68:2272-2283.
[24] Potpara TS, Lenarczyk R, Larsen TB, et al. Management of atrial fibrillation in patients with chronic kidney disease in europe results of the european heart rhythm association survey[J]. Europace, 2015, 17:1862-1867.