rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2021-02-03rpcardio-2389Research ArticleASSOCIATED PROBLEMS OF CARDIOLOGYСМЕЖНЫЕ ВОПРОСЫ КАРДИОЛОГИИDirect Oral Anticoagulants in Patients with Atrial Fibrillation and Renal DysfunctionПрямые оральные антикоагулянты у пациентов с фибрилляцией предсердий и дисфункцией почекhttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZ. D.

Кобалава Жанна Давидовна

Москва

eLibrary SPIN 9828-5409

Zhanna D. Kobalava

Moscow

eLibrary SPIN 9828-5409

https://orcid.org/0000-0003-3929-431XШаваровА. А.ShavarovA. A.

Шаваров Андрей Анатольевич

Москва

eLibrary SPIN 2506-1546

Andrey A. Shavarov

Moscow

eLibrary SPIN 2506-1546

shavarov@yahoo.comhttps://orcid.org/0000-0001-9806-4464Вацик-ГородецкаяМ. В.Vatsik-GorodetskayaM. V.

Вацик-Городецкая Мария Васильевна

Москва

Maria V. Vatsik-Gorodetskaya

 

Российский университет дружбы народовРоссияPeoples Friendship University of Russia (RUDN University)Russian FederationГородская клиническая больница им. В.В. ВиноградоваРоссияV.V. Vinogradov City Clinical HospitalRussian Federation2021020320211716272Copyright © Kobalava Z.D., Shavarov A.A., Vatsik-Gorodetskaya M.V., 20212021Кобалава Ж.Д., Шаваров А.А., Вацик-Городецкая М.В.Kobalava Z.D., Shavarov A.A., Vatsik-Gorodetskaya M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2389

Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.

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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The authors declare that there are no conflicts of interest present.