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Dialyse aktuell 2021; 25(07): 266-272
DOI: 10.1055/a-1401-3183
Schwerpunkt
Nephrologie

Antikoagulation bei chronisch nierenkranken Menschen mit Vorhofflimmern

Neue Antikoagulanzien (NOAK), Phenprocoumon oder Verzicht auf Antikoagulation?
Stephan H. Schirmer
1   Stephan H. Schirmer, Kardiopraxis Schirmer, Kaiserslautern
2   Universität des Saarlandes, Homburg/Saar
,
Vincent Brandenburg
3   Klinik für Kardiologie und Nephrologie, Rhein-Maas Klinikum Würselen
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ZUSAMMENFASSUNG

Bei Patienten mit Vorhofflimmern besteht ein erhöhtes Risiko für thromboembolische Komplikationen und insbesondere Schlaganfall. Patienten mit chronischer Nierenerkrankung haben gehäuft Vorhofflimmern und sowohl ein erhöhtes Blutungs- wie auch Schlaganfallrisiko. Für Patienten mit einer Kreatinin-Clearance von bis zu 25–30 ml/min sind Nicht-Vitamin-K-abhängige orale Antikoagulanzien (NOAK) evidenzbasiert zur Schlaganfallprävention den Vitamin-K-Antagonisten (VKA) vorzuziehen. Darunter bzw. bei Dialysepatienten liegen keine wissenschaftlichen Daten vor; hier muss das Konzept (keine Antikoagulation vs. NOAK vs. Vorhofohrverschluss vs. VKA) individuell entschieden werden, wobei die Gabe von VKA die schlechteste Lösung zu sein scheint.



Publikationsverlauf

Artikel online veröffentlicht:
10. September 2021

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  • Literatur

  • 1 Hart RG, Eikelboom JW, Brimble KS. et al Stroke prevention in atrial fibrillation patients with chronic kidney disease. Can J Cardiol 2013; 29 Suppl S71-S78
    CrossrefPubMedSuche in Google Scholar
  • 2 Ha JT, Neuen BL, Cheng LP. et al Benefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease: A Systematic Review and Meta-analysis. Ann Intern Med 2019; 171: 181-189
    CrossrefPubMedSuche in Google Scholar
  • 3 Lip GY, Frison L, Halperin JL. et al Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010; 41: 2731-2738
    CrossrefPubMedSuche in Google Scholar
  • 4 Granger CB, Alexander JH, McMurray JJ. et al Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981-992
    CrossrefPubMedSuche in Google Scholar
  • 5 Connolly SJ, Ezekowitz MD, Yusuf S. et al Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 2009; 361: 1139-1151
    CrossrefPubMedSuche in Google Scholar
  • 6 Giugliano RP, Ruff CT, Braunwald E. et al Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013; 369: 2093-2104
    CrossrefPubMedSuche in Google Scholar
  • 7 Patel MR, Mahaffey KW, Garg J. et al Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med 2011; 365: 883-891
    CrossrefPubMedSuche in Google Scholar
  • 8 Hijazi Z, Hohnloser SH, Oldgren J. et al Efficacy and safety of dabigatran compared with warfarin in relation to baseline renal function in patients with atrial fibrillation: a RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial analysis. Circulation 2014; 129: 961-970
    CrossrefPubMedSuche in Google Scholar
  • 9 Hohnloser SH, Hijazi Z, Thomas L. et al Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J 2012; 33: 2821-2830
    CrossrefPubMedSuche in Google Scholar
  • 10 Hijazi Z, Alexander JH, Li Z. et al Apixaban or Vitamin K Antagonists and Aspirin or Placebo According to Kidney Function in Patients With Atrial Fibrillation After Acute Coronary Syndrome or Percutaneous Coronary Intervention. Circulation 2021; 143: 1215-1223
    CrossrefPubMedSuche in Google Scholar
  • 11 Fox KAA, Piccini JP, Wojdyla D. et al Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J 2011; 32: 2387-2394
    CrossrefPubMedSuche in Google Scholar
  • 12 Bohula EA, Giugliano RP, Ruff CT. et al Impact of Renal Function on Outcomes With Edoxaban in the ENGAGE AF-TIMI 48 Trial. Circulation 2016; 134: 24-36
    CrossrefPubMedSuche in Google Scholar
  • 13 Steffel J, Verhamme P, Potpara TS. et al The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39: 1330-1393
    CrossrefPubMedSuche in Google Scholar
  • 14 Hindricks G, Potpara T, Dagres N. et al 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 42: 373-498
    CrossrefPubMedSuche in Google Scholar
  • 15 Böhm M, Ezekowitz MD, Connolly SJ. et al Changes in Renal Function in Patients With Atrial Fibrillation: An Analysis From the RE-LY Trial. J Am Coll Cardiol 2015; 65: 2481-2493
    CrossrefPubMedSuche in Google Scholar
  • 16 Sitticharoenchai P, Takkavatakarn K, Boonyaratavej S. et al Non-Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non-Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis. J Am Heart Assoc 2021; 10: e019609
    CrossrefPubMedSuche in Google Scholar
  • 17 Yao X, Tangri N, Gersh BJ. et al Renal Outcomes in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol 2017; 70: 2621-2632
    CrossrefPubMedSuche in Google Scholar
  • 18 Nigwekar SU, Thadhani R, Brandenburg VM. Calciphylaxis. N Engl J Med 2018; 378: 1704-1714
    CrossrefPubMedSuche in Google Scholar
  • 19 Turagam MK, Osmancik P, Neuzil P. et al Left Atrial Appendage Closure Versus Oral Anticoagulants in Atrial Fibrillation: A Meta-Analysis of Randomized Trials. J Am Coll Cardiol 2020; 76: 2795-2797
    CrossrefPubMedSuche in Google Scholar
  • 20 Nielsen-Kudsk Jens E, Korsholm K, Damgaard D. et al Clinical Outcomes Associated With Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation. JACC: Cardiovascular Interventions 2021; 14: 69-78
    CrossrefPubMedSuche in Google Scholar
  • 21 Heine GH, Brandenburg V, Schirmer SH. Oral Anticoagulation in Chronic Kidney Disease and Atrial Fibrillation. Dtsch Arztebl Int 2018; 115: 287-294
    CrossrefPubMedSuche in Google Scholar
  • 22 Siontis KC, Zhang X, Eckard A. et al Outcomes Associated with Apixaban Use in End-Stage Kidney Disease Patients with Atrial Fibrillation in the United States. Circulation 2018; 138: 1519-1529
    CrossrefPubMedSuche in Google Scholar
  • 23 Kuno T, Takagi H, Ando T. et al Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis. J Am Coll Cardiol 2020; 75: 273-285
    CrossrefPubMedSuche in Google Scholar
  • 24 De Vriese AS, Caluwé R, Pyfferoen L. et al Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with Atrial Fibrillation: the Valkyrie Study. J Am Soc Nephrol 2020; 31: 186-196
    CrossrefPubMedSuche in Google Scholar
  • 25 Pokorney S. RENal hemodialysis patients ALlocated apixaban versus warfarin in Atrial Fibrillation – RENAL-AF. ACC Congress presentation 2019
    PubMedSuche in Google Scholar
  • 26 Reinecke H, Jürgensmeyer S, Engelbertz C. et al Design and rationale of a randomised controlled trial comparing apixaban to phenprocoumon in patients with atrial fibrillation on chronic haemodialysis: the AXADIA-AFNET 8 study. BMJ Open 2018; 08: e022690
    CrossrefPubMedSuche in Google Scholar
  • 27 Schirmer SH, Brandenburg V, Antlanger M. [Anticoagulation and anti platelet therapy in patients with chronic kidney disease]. Dtsch Med Wochenschr 2019; 144: 1423-1427
    Thieme ConnectPubMedSuche in Google Scholar