在血液透析患者的心房动治疗和中风预防
Václav Melenovský1,2, Pavel Osmančík3,4
1Department of Cardiology, Kralovske Vinohrady University Hospital, Prague, Czech Republic.
Kardiologia polska
|January 8, 2024
概括
患有心房 (AF) 和慢性病 (CKD) 的患者面临高中风和出血风险. 在血液透析 (HD) 患者中,用于预防AF中风的抗凝药需要仔细的个体评估,有利于选择出血风险较低的患者.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 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,特别是血液透析 (HD) 患者中,心房动 (AF) 的高患病率.
- 在患有AF的CKD患者中,缺血性中风和出血事件的风险增加.
- 缺乏明确的指导方针和随机试验,用于预防晚期CKD和AF中风的抗凝血药物.
研究的目的:
- 审查CKD/HD患有AF的患者抗凝药的观察性和随机研究.
- 讨论在这个人群中预防中风的抗凝剂的个性化使用.
- 突出正在进行的研究和替代策略,如左心房尾关闭.
主要方法:
- 对CKD/HD患有AF的患者抗凝血的观察性研究的综述.
- 随机试验的讨论,比较维生素K对抗剂 (VKAs) 与非维生素K对抗剂 (NOACs) 在CKD患者中.
- 提到正在进行的随机化研究,这些研究涉及降低剂量的阿皮克萨班,XI因子抑制剂和左心房尾关闭.
主要成果:
- 在患有AF的CKD/HD患者中,抗凝药在血栓和出血风险之间呈现出复杂的平衡.
- 个性化患者评估至关重要,抗凝药可能在精选的高中风,低出血风险个体中是合理的.
- 降低剂量的DOACs (例如,阿皮克萨班) 和左心房尾关闭是新兴的策略.
结论:
- 由于高出血风险,不建议在患有HD的AF患者中预防中风的常规抗凝药.
- 个性化治疗策略至关重要,考虑到中风和出血风险.
- 需要进一步的研究,包括正在进行的随机试验,以澄清最佳的抗凝药和替代疗法.
相关概念视频
01:27Dialysis
319
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...
319
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
701
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...
701
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
432
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
432
01:22Heart Failure Drugs: Diuretics
384
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...
384
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
1.4K
Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
1.4K
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
836
Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
836