Literature Case Analysis of Anticoagulant-Related Nephropathy Induced by Direct Oral Anticoagulants
OBJECTIVE:To investigate the clinical characteristics of anticoagulant-related nephropathy(ARN)induced by direct oral anticoagulants,so as to provide reference for clinical safe drug use.METHODS:Relevant literature databases at home and abroad(up to Sept.30th,2023)were retrieved,case report literature related to ARN induced by direct oral anticoagulants were collected.Patients'gender,age,medication,comorbidities,occurrence of renal injury were recorded and statistically analyzed.RESULTS:A total of 36 patients were enrolled(3 domestic cases and 33 foreign cases),including 26 cases of dabigatran etexilate,7 cases of rivaroxaban,and 3 cases of apixaban.There were 23 males and 13 females,the age ranged from 59 to 89 years,with an average age of 75.75 years.Totally 22 cases had normal renal function and 14 cases had a history of chronic renal disease.Thirty-six patients had comorbidities/past medical history;22 cases had drug combination and 14 cases were not mentioned.The time from the use of anticoagulants to occurrence of renal injury was 2 d to 3 years,of which 30 cases had renal injury within 1 year.Renal biopsy was performed in 24 patients.Serum creatinine levels increased in 36 patients,mainly manifested as hematuria(16 cases of gross hematuria,7 cases of microscopic hematuria),and a few patients showed oliguria(7 cases),anuria(1 case)or proteinuria(10 cases).After the diagnosis of renal injury,36 patients stopped using direct oral anticoagulants and received different treatments.Among them,6 patients received idarucizumab(dabigatran etexilate reversal agent),14 patients underwent hemodialysis,15 patients received glucocorticoid treatment,and 6 patients received intravenous fluid.After drug withdrawal and symptomatic treatment,the renal function of 24 patients was improved or returned to normal,but there were still 6 patients showed no improvement,3 patients deteriorated,and 3 patients died(died from other complications).CONCLUSIONS:Clinically,it is necessary to be alert to the occurrence of ARN induced by direct oral anticoagulants,pay close attention to patients'renal function and clinical manifestations such as hematuria during medication,identify and diagnose as soon as possible,and perform renal biopsy if necessary.Once ARN occurs,symptomatic supportive treatment should be given according to the patients'condition.
万方数据
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