在患有慢性病的患者中使用抗凝固药
Elias John Elenjickal1, Christoforos K Travlos1, Pedro Marques1
1Division of Nephrology, Department of Medicine, McGill University Health Centre and Research Institute, Montreal, Québec, Canada.
American journal of nephrology
|November 30, 2023
概括
直接口服抗凝剂 (DOAC) 对慢性病 (CKD) 和心房动或静脉血栓栓塞 (VTE) 的患者来说比华法林提供了优势. 剂量调整对于中度至重度的CKD至关重要,对透析患者要谨慎考虑.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在慢性病 (CKD) 患者中,心房动 (AF) 和静脉血栓塞栓症 (VTE) 是常见的.
- 华法林是标准的抗凝剂,但直接口服抗凝剂 (DOAC) 在一般人群中提供了更好的安全性和有效性.
- 本综述检查了DOAC使用的证据,特别是在CKD患者中.
研究的目的:
- 对慢性病患者使用直接口服抗凝剂 (DOAC) 的现有证据进行审查和综合.
- 为了比较DOACs与华法林在AF和VTE治疗/预防中风预防中的疗效和安全性.
- 提供关于在CKD患者中DOAC选择和剂量的指导.
主要方法:
- 对AF和VTE的DOAC的主要随机对照试验 (RCT) 的后期分析的审查.
- 包括回顾性观察性研究,评估高级CKD和AF中DOACs.
- 从特定试验的数据分析,如VALKYRIE,AXADIA和RENAL-AF关于透析患者抗凝剂.
主要成果:
- 在中度CKD (CrCl 30-50毫升/分钟) 中,达比加特兰和阿皮克萨班的中风/全身血栓塞率较低;与华法林相比,阿皮克萨班和埃多克萨班的出血/死亡率较低.
- 在晚期CKD (CrCl <30毫升/分钟) 中,DOACs表现出类似于华法林的疗效,但出血率可能更低.
- 里瓦罗克萨班在VALKYRIE试验扩展阶段对透析患者优于VKAs;这个组的其他试验没有确定性.
结论:
- 在中度至严重的CKD中,DOACs优先于华法林治疗AF和VTE,需要适当的剂量调整.
- 治疗药物监测可以考虑个性化患者管理.
- 由于DOAC和VKA的高出血风险,在透析患者中服用口服抗凝剂的必要性是可疑的.
相关概念视频
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
711
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
711
01:11Renal Failure: Dose Adjustments
95
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
95
01:17Factors Affecting Renal Clearance: Renal Impairment
99
Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
99
01:22Heart Failure Drugs: Diuretics
396
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
396
01:27Dialysis
322
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
322