Abstract：
Atrial fibrillation (AF) is highly prevalent in patients with chronic kidney disease (CKD). It is associated with an increased risk of stroke, which increases as kidney function declines. In the general population and in those with a moderate degree of CKD (creatinine clearance 30-50 mL/min), the use of oral anticoagulation to decrease the risk of stroke has been the standard of care based on a favorable risk-benefit profile that had been established in seminal randomized controlled trials. However, evidence regarding the use of oral anticoagulants for stroke prevention is less clear in patients with severe CKD (creatinine clearance <30 mL/min) and those receiving maintenance dialysis, as these individuals were excluded from such large randomized controlled trials. Nevertheless, the direct oral anticoagulants have invariably usurped vitamin K antagonists as the preferred choice for oral anticoagulation among patients with AF across all strata of CKD based on their well-defined safety and efficacy and multiple pharmacokinetic benefits (e.g., less drug-drug interactions). This review summarizes the current literature on the role of oral anticoagulation in the management of AF among patients with CKD and highlights current deficiencies in the evidence base and how to overcome them.
摘要：
心房颤动（AF）在慢性肾脏病（CKD）患者中非常普遍。它与中风风险增加有关，随着肾功能的下降而增加。在一般人群和中度CKD（肌酐清除率30-50mL/min）的人群中，使用口服抗凝药降低卒中风险已成为一项标准治疗,其基础是在开创性随机对照试验中确立的有利的风险-获益特征.然而,在重度CKD(肌酐清除率<30mL/min)和接受维持性透析的患者中,使用口服抗凝药预防卒中的证据不太明确,因为这些个体被排除在此类大型随机对照试验之外.然而，根据明确定义的安全性和有效性以及多种药代动力学益处，直接口服抗凝剂总是在CKD的所有阶层中滥用维生素K拮抗剂作为房颤患者口服抗凝的首选（例如，更少的药物-药物相互作用)。这篇综述总结了目前关于口服抗凝药在CKD患者房颤治疗中的作用的文献，并强调了目前证据基础上的不足以及如何克服这些不足。
