32例新型口服抗凝药致急性肾损伤的文献病例分析
Literature case analysis of 32 patients with acute kidney injury induced by novel oral anticoagulants
吴登科 1周增慧 2杭永付 1朱建国 1谢诚1
作者信息
- 1. 苏州大学附属第一医院药学部,江苏苏州 215000
- 2. 苏州市独墅湖医院药学部,江苏苏州 215000
- 折叠
摘要
目的:探讨新型口服抗凝药(novel oral anticoagulants,NOACs)致急性肾损伤(acute kidney injury,AKI)的发生情况和特点,为临床安全用药提供参考.方法:检索建库至2023年3月收录在PubMed、Embase、中国知网、万方和维普期刊数据库有关NOACs致AKI的病例报道,并对相关数据进行统计和分析.结果:共检索到29篇文献合计32例患者,男性16例(50％)、女性16例(50％),年龄59～86(74.0±7.2)岁,≥60岁的有31例(96.9％).使用达比加群酯21例(65.6％),利伐沙班7例(21.9％),阿哌沙班3例(9.4％),艾多沙班1例(3.1％).发现AKI的中位时间为51 d,其中有19例(59.4％)为3个月内.所有患者的肾小球滤过率均小于30 mL·min-1·(1.73 m2)-1,发生3级AKI的有27例(84.4％),并有24例(75.0％)伴有不同程度的血尿.经停药、皮质类固醇和血液透析等治疗后26例(81.2％)转归良好.结论:不同的NOACs均可导致AKI,且以达比加群酯居多.当患者出现血尿时应考虑可能是其导致的AKI.对于高龄且合并多种基础疾病及联用具有肾损伤风险的药物时应加强对患者肾功能的检测,尤其是用药前3个月.一旦发生AKI应及时停用并根据病理类型进行针对性治疗.
Abstract
OBJECTIVE To discuss the occurrence and clinical characteristics of acute kidney injury(AKI)induced by novel oral anticoagulants(NOACs)in order to provide reference for safe clinical drug use.METHODS The case reports of AKI induced by NOACs were retrieved from PubMed,Embase,CNKI,Wanfang and VIP database from inception to March 2023.The relevant data were collected and analyzed.RESULTS A total of 32 cases from 29 articles were identified and included in the analysis,including 16 males(50％)and 16 females(50％).The patients were aged from 59 to 86 years with an average age of(74.0±7.2)years old,and there were 31 patients aged 60 and above(96.9％).Totally 21(65.6％)cases were treated with dabigatran etexilate,7 cases(21.9％)with rivaroxaban,3 cases(9.4％)with apixaban,and 1 case(3.1％)with edoxaban(22.7％).The median time found for AKI was 51 days,and that of 19 cases(59.4％)was within 3 months.All the patients were with glomerular filtration rates less than 30 mL·min-1·(1.73 m2)-1.Meanwhile,27 cases(84.4％)had grade 3 AKI and 24 cases(75.0％)suffered varying degrees of hematuria.After drug withdrawal,corticosteroids treatment and hemodialysis,26 cases(81.2％)had good outcomes.CONCLUSION Different NOACs can cause AKI,and AKI is more common caused by dabigatran etexilate.A possible association with AKI should be considered while hematuria appears.For elderly patients with mul-tiple underlying diseases treated with drugs with risk of kidney injury,the detection of renal function should be strengthened,espe-cially during the first 3 months.Once AKI happens,NOACs must be stopped in time and targeted treatment should be carried out according to the pathological type.
关键词
新型口服抗凝药/急性肾损伤/抗凝药相关性肾病/文献病例分析Key words
novel oral anticoagulant/acute kidney injury/anticoagulant-related nephropathy/literature case analysis引用本文复制引用
基金项目
国家临床重点专科(临床药学)建设项目()
卫生部部属(管)医疗机构临床学科重点建设专项(国卫办医函[2018]292号)
出版年
2024
NETL
NSTL
维普
万方数据