Atrial Fibrillation and Thromboembolism in Patients With Chronic Kidney Disease

作者：Lau Yee C; Proietti Marco; Guiducci Elisa; Blann Andrew D; Lip Gregory Y H

来源：Journal of the American College of Cardiology, 2016, 68(13): 1452-1464.

DOI：10.1016/j.jacc.2016.06.057

• anticoagulation
• bleeding risk
• stroke prevention

A bidirectional relationship exists between atrial fibrillation (AF) and chronic renal disease. Patients with AF have a higher incidence of renal dysfunction, and the latter predisposes to incident AF. The coexistence of both conditions results in a higher risk for thromboembolic-related adverse events but a paradoxical increased hemorrhagic risk. Oral anticoagulants (both vitamin K antagonists [VKAs] and non-VKA oral anticoagulants [NOACs]) have been demonstrated to be effective in mild to moderate renal dysfunction. Patients with severe renal impairment were excluded from the non-VKA oral anticoagulant trials, so limited data are available. In end-stage renal failure, the net clinical benefit of VKAs in dialysis-dependent patients remains uncertain, although some evidence suggests that such patients may do well with high-quality anticoagulation control. Risk stratification and careful follow-up of such patients are necessary to ensure a net clinical benefit from thromboprophylaxis.

• 出版日期2016-9-27