期刊
AMERICAN JOURNAL OF MEDICINE
卷 130, 期 9, 页码 1015-1023出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2017.04.015
关键词
Atrial fibrillation; Direct oral anticoagulants
资金
- Daiichi Sankyo
Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants (DOACs) have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, DOACs were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in nonvalvular atrial fibrillation patients with mild or moderate renal impairment. Renal function decrease appears less impacted by DOACs, which are associated with a better risk-benefit profile than warfarin in patients with decreasing renal function over time. Limited data address the risk-benefit profile of DOACs in patients with severe impairment or on dialysis. (C) 2017 Published by Elsevier Inc.
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