慢性肾脏病合并心房颤动的经皮冠状动脉介入治疗术后患者抗栓治疗的安全性研究进展

    Advances of safety of antithrombotic therapy in patients with chronic kidney disease plus atrial fibrillation after percutaneous coronary intervention

    • 摘要: 心房颤动的患者常常继发冠状动脉疾病,出现急性冠脉综合征或需要经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)。抗凝、抗血小板治疗是心房颤动患者接受PCI术后的标准化治疗方案,但其有出血的风险。肾功能会影响出血事件的发生,进而影响抗栓药物使用的利弊平衡。本文旨在探讨慢性肾脏病(chronic kidney disease,CKD)合并心房颤动的PCI术后患者抗栓治疗的安全性。利用Pubmed、Cochrane、Embase数据库,检索国内外公开发表的关于CKD合并心房颤动并接受PCI术后抗栓治疗的研究文献。经分析,与使用维生素K拮抗剂的患者相比,使用直接口服抗凝药(direct oral anticoagulants,DOAC)的患者出血事件发生较少,提示对于CKD合并心房颤动且接受PCI术后的患者使用DOAC抗凝治疗较维生素K拮抗剂安全性更高,且对于估算肾小球滤过率>30 mL·min−1·(1.73 m2−1的CKD患者,肾功能的进展对DOAC的安全性无明显影响。

       

      Abstract: Patients of atrial fibrillation (AF) are prone to develop secondary coronary artery disease (CAD) and acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) is required. Anticoagulation and antiplatelet therapy are a gold standard for AF patients with post-PCI. However, there is a great risk of hemorrhage. Renal function affects the occurrence of hemorrhagic events and then shifts a balance of advantages and disadvantages of antithrombotic therapy. The safety of antithrombotic therapy was explored in patients with chronic kidney disease (CKD) complicated with AF post-PCI. The databases of PubMed, Cochrane and EMBASE were searched for cohort research studies of CKD plus AF patients on antithrombotic therapy post-PCI. As compared with those taking vitamin K antagonists, users of direct oral anticoagulants (DOAC) had fewer hemorrhagic events. For CKD plus AF patients post-PCI, the safety of DOAC was higher than those taking vitamin K antagonists. For patients with eGFR >30 mL·min−1·(1.73 m2−1, the progression of CKD had no significant impact on the safety of DOAC.

       

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