Page 80 - GALENIKA MEDICAL JOURNAL

Zaključak

Izabrati odgovarajući OAC kod bolesnika sa AF i završnim stadijumom bubrežne slabosti predstavlja
veliki izazov za lekara. Potrebno je razmotriti upotrebu OAC u skladu sa smernicama za dijagnostiku
i lečenje AF, Evropskog udruženja kardiologa kod bolesnika sa završnim stadijumom bubrežne
slabosti i onih na hemodijalizi ili na terapiji zamene bubrega koji imaju povećan rizik od moždanog
udara ili sistemske embolije kod svih bolesnika sa AF i završnim stadijumom bubrežne slabosti

koji ispunjavaju uslove za OAC (oni bez protetskog mehaničkog srčanog zalistka ili umerene do
teške stenoze mitralne valvule). Dostupni dokazi sugerišu da upotreba NOAC dovodi do sporijeg
pogoršanja bubrežne funkcije u poređenju sa VKA. Takođe, trenutni dokazi sugerišu da su NOAC
bezbedni i efikasni kao VKA kod bolesnika sa AF i CKD, ali će za definitivnu promenu smernica za
primenu antikoagulacije kod bolesnika sa završnim stadijumom bubrežne slabosti biti potrebna dalja
ispitivanja. Međutim, da bi se bolje razumeli mehanizmi različitih efekata specifičnih NOAC agensa
kod bolesnika sa završnim stadijumom bubrežne slabosti, potrebno je više podataka i na taj način bi
se mogao postići optimalan izbor specifičnog OAC agensa kod pojedinačnih bolesnika.

Abstract

Patients with end-stage kidney failure have an increased risk of atrial fibrillation (AF). Chronic kidney disease (CKD)
and AF share several common risk factors for the onset of the disease, as well as an increased risk of stroke, systemic
thromboembolism, major bleeding and mortality. Adverse events are most common in patients with end-stage kidney
disease. The risks of thromboembolism and bleeding increase with increasing severity of CKD in patients with AF.
Evaluation of the advantages of oral anticoagulants (OAC) for thromboprophylaxis in patients with advanced kidney
dysfunction, is a big challenge due to its deficiency of high-quality evidence from randomized clinical trials and conflicting
data from observational studies. In this review, we considered the use and effects of specific OAC agents in patients with
AF and end-stage kidney disease. In addition, we provide an expert opinion on the choice of optimal OAC therapy for the
prevention of stroke in these patients.

Patients with AF and end-stage kidney disease should benefit from the use of OAC. The use of OACs should be considered
in patients with AF and end-stage kidney disease and those on dialysis or kidney replacement therapy who are at increased
risk of stroke or systemic embolism in all patients eligible for OACs with AF and end-stage kidney disease (ie. those without
a prosthetic mechanical heart valve or moderate to severe mitral valve stenosis). However, the effect of non-vitamin K
oral anticoagulants (NOACs) on kidney function has not been sufficiently investigated. More data are needed to better
understand the mechanisms of NOAC effects on kidney function, which requires clear clinical guidelines derived from
randomized clinical trials.

Keywords: end-stage kidney failure, atrial fibrillation, chronic kidney disease, oral anticoagulants, non-vitamin K oral
anticoagulants

78 DOI: 10.5937/Galmed2412058S