Tom 12, Nr 1 (2017)
Artykuł przeglądowy
Opublikowany online: 2017-03-03
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Profilaktyka powikłań zakrzepowo-zatorowych u chorych z migotaniem przedsionków i przewlekłą chorobą nerek — pozycja nowych doustnych antykoagulantów
DOI: 10.5603/FC.2017.0007
Folia Cardiologica 2017;12(1):68-77.
Streszczenie
Migotanie przedsionków (AF) jest najczęściej występującym zaburzeniem rytmu serca w populacji ogólnej. Przewlekłą chorobę nerek (CKD) zalicza się do czynników ryzyka występowania AF, a jej obecność w znacznym stopniu wpływa na dobór leków stosowanych w profilaktyce powikłań zakrzepowo- zatorowych u pacjentów z tą arytmią. Ocena funkcji nerek jest niezbędna zarówno przed wdrożeniem leczenia przeciwkrzepliwego, jak i w jego trakcie. U chorych na CKD w 3. stadium za leki pierwszego wyboru uznaje się: apiksaban w dawce 5 mg 2 razy/dobę, riwaroksaban w dawce 15 mg raz/ /dobę oraz edoksaban w dawce 30 mg raz/dobę. Leki z grupy antagonistów witaminy K są przeznaczone dla chorych z AF i CKD niezależnie od jej stadium, są również dedykowane dla chorych dializowanych. U chorych z CKD należy wnikliwie rozważyć bilans korzyści do ryzyka terapii przeciwkrzepliwej, dotyczy to szczególnie chorych dializowanych ze względu na stosowanie heparyny w trakcie hemodializy. Nowe doniesienia na temat stosowania nowych doustnych antykoagulantów mogą w przyszłości rozszerzyć wskazania do stosowania tej grupy leków u chorych z CKD.
Słowa kluczowe: leki przeciwzakrzepoweprzewlekła choroba nerekmigotanie przedsionkówantagoniści witaminy Kriwaroksabanapiksabandabigatranedoksaban
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