Selección del tratamiento anticoagulante óptimo para el paciente con fibrilación auricular y diabetes o enfermedad renal crónica: papel del rivaroxabán

Q4 Medicine
José María Cepeda , Vicente Ignacio Arrarte Esteban , Lorenzo Facila Rubio , Vicente Giner Galvañ , Jose Luis Górriz , Javier Trujillo Santos , Juan José Tamarit Garcia
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引用次数: 0

Abstract

Both diabetes mellitus and chronic kidney disease increase the risk of atrial fibrillation. In turn, the coexistence of diabetes and chronic kidney disease synergistically increases the thromboembolic risk associated with atrial fibrillation, which puts affected patients at a particularly high risk and makes it necessary to focus treatment not only on reducing the risk of embolism but also on providing more general prophylaxis. Although all oral anticoagulants are effective in reducing the risk of stroke in diabetic patients with atrial fibrillation, there are indications that rivaroxaban could also reduce cardiovascular mortality in this population, thereby providing additional benefits. Moreover, it has been reported that renal function deteriorates on vitamin K antagonist treatment (i.e. warfarin-related nephropathy). Consequently, the ideal anticoagulant treatment would decrease the risk of thromboembolic complications without also being associated with impaired renal function. In this context, it appears that some direct oral anticoagulants, such as dabigatran and rivaroxaban, may have a lower risk of adverse renal events than warfarin.

心房颤动与糖尿病或慢性肾病患者抗凝治疗的最佳选择:利伐沙班的作用
糖尿病和慢性肾脏疾病都会增加房颤的风险。反过来,糖尿病和慢性肾脏疾病的共存协同增加了与房颤相关的血栓栓塞风险,这使受影响的患者处于特别高的风险,因此有必要将治疗重点放在降低栓塞风险上,同时提供更全面的预防。虽然所有口服抗凝剂都能有效降低糖尿病心房颤动患者的卒中风险,但有迹象表明,利伐沙班也能降低这类人群的心血管死亡率,从而提供额外的益处。此外,据报道,维生素K拮抗剂治疗后肾功能恶化(即华法林相关性肾病)。因此,理想的抗凝治疗将降低血栓栓塞并发症的风险,而不会导致肾功能受损。在这种情况下,一些直接口服抗凝剂,如达比加群和利伐沙班,可能比华法林有更低的肾脏不良事件风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Revista Espanola de Cardiologia Suplementos
Revista Espanola de Cardiologia Suplementos Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
1
期刊介绍: Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.
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