Статья
Прямые оральные антикоагулянты у пациентов с фибрилляцией предсердий и дисфункцией почек
Фибрилляция предсердий и хроническая болезнь почек часто сосуществуют, и каждое из этих заболеваний может предрасполагать к развитию другого и способствовать ухудшению прогноза. И фибрилляция предсердий, и хроническая болезнь почек асоциированы с повышенным риском инсульта и тромбоэмболических осложнений, поэтому антикоагулянтная терапия с целью профилактики инсульта рекомендована пациентам с фибрилляцией предсердий и сниженной функцией почек. Каждый прямой оральный антикоагулянт обладает уникальными фармакологическими свойствами, которые клиницист должен знать, чтобы обеспечить оптимальное лечение. Дозы прямых оральных антикоагулянтов требуют коррекции в зависимости от состояния функции почек. Продолжаются споры относительно выбора уравнения, уравнения CKD-EPI или уравнения Кокрофта-Голта для оценки расчетной скорости клубочковой фильтрации у пациентов с фибрилляцией предсердий, получающих прямые оральные антикоагулянты. В данном обзоре рассматриваются аргументы в пользу применения прямых оральных антикоагулянтов у пациентов с нарушением функции почек.
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