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房颤合并慢性肾病的抗凝策略

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房颤(Atrial fibrillation, AF)和慢性肾脏疾病( chronic kidney disease ,CKD)的多种致病因素常存在共通性,高血压、糖尿病和冠状动脉疾病。当不合并CKD时,对房颤患者开展抗凝治疗是毋庸置疑的,但此做法不适用于房颤合并晚期CKD的患者群(advanced CKD)。随着CKD患者肾功能的下降,缺血性卒中和出血的危险逐渐增加,使抗凝治疗趋向复杂。现存随机对照试验尚不能得出明确辅助临床决策的指南性意见,而观察性研究的结果相互矛盾。在最新JACC综述Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation: JACC Review Topic of the Week,作者概述了相关病理生理学机制,总结CKD合并AF的抗凝策略及研究进展, 并就如何在这些患者中使用口服抗凝给出建议

该文核心要点可参阅CBSMD文献导读Anticoagulation in Concomitant CKD and AF”。