Abstract
Chronic kidney disease (CKD) is a powerful cardiovascular risk factor, its presence is accompanied by an increased risk of hospitalization for exacerbation of chronic heart failure (CHF), adverse outcomes in myocardial infarction, and cardiovascular mortality. Among the adverse events, an increased risk of atrial fibrillation (AF) should be noted. This article contains discussion of current approaches to the treatment of AF in patients with different stages of CKD, data on benefits of certain direct oral anticoagulants, as well as comparative characteristics of therapy with direct oral anticoagulants and warfarin. Pharmacokinetics and pharmacodynamics of direct oral anticoagulants, which determine the features of therapy in CKD, are also considered.
Highlights
its presence is accompanied by an increased risk of hospitalization
which determine the features of therapy in Chronic kidney disease (CKD)
the risk exceed the benefit for anticoagulation in end-stage renal disease patients
Summary
ППОАК – прямые пероральные антикоагулянты; CYP2C9 – цитохром P450 тип 2С9; Ха – фактор Ха; CYP3A4 – цитохром Р450 тип 3А4. * – в РФ не зарегистрирован. Открывшими возможности применения ППОАК с витамин К-неза висимым механизмом действия при ФП у больных с ХБП, являются ROCKET-AF, RE-LY, ARISTOTLE и ENGAGE AF-TIMI У пациентов с умеренным нарушением функции почек, Clcr 30–50 мл / мин результаты исследований ROCKET-AF, ARISTOTLE и RE-LY дают ответ о возможности применения ППОАК в их дозировках. В крупном исследовании ROCKET-AF первичная конечная точка была достигнута у 188 больных в группе ривароксабана (1,7 % в год) и у 241 больного в группе варфарина (2,2 % в год; относительный риск – ОР 0,79 при 95 % ДИ от 0,66 до 0,96; p
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