New Type of Oral Anticoagulants Bring Down Risk of Kidney Damage
등록일 2019년 01월 07일 화요일
수정일 2017년 11월 21일 화요일

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Researchers from the Mayo Clinic found a type of oral anticoagulant that may result in better kidney outcomes among atrial fibrillation patients.In the study, the researchers determined the safety and efficacy of a non-vitamin K antagonist oral anticoagulant and pitted it against the standard warfarin drug.

Atrial fibrillation is an irregular or quivering heartbeat that can result in stroke, heart failure, and blood clots.It is normally treated with warfarin to prevent strokes from happening.Warfarin is an anticoagulant or blood thinner that blocks an enzyme called vitamin K epoxide reductase.This enzyme reactivates vitamin K1 that affects blood clotting.However, anticoagulants such as warfarin and heparin, can cause kidney damage.

"Kidney function decline in patients taking oral anticoagulant drugs is an important topic that has been overlooked in previous clinical trials.Our study demonstrated that renal function decline is very common among atrial fibrillation patients on blood thinners," said Dr.Xiaoxi Yao, the lead author of the study.

About one in four patients suffers from significantly reduced kidney function within two years under anticoagulant medications.While one in seven patients can develop acute kidney injury caused by anticoagulants, according to Dr.Yao.

Their study involved the de-identified records of 9,769 patients from the OptumLabs Data Warehouse.These patients had been diagnosed with atrial fibrillation and were prescribed oral anticoagulants which they took between October 1, 2010 and April 30, 2016.The anticoagulants found in the data includes apixaban, dabigatran, rivaroxaban, and warfarin.

They found four indicators of kidney function in the data – 30 percent decline in the kidneys' waste filtering function, twice the amount of serum creatinine level or waste products, acute kidney injury, and kidney failure.The researchers also proved kidney function decline in the patients after calculating the cumulative risks of the four indicators within two years of anticoagulant use.

- Cumulative risk of 24.4 percent to develop decline waste filtering function of the kidneys.

- Cumulative risk of 4 percent to develop increased of waste products in the kidneys.

- Cumulative risk of 14.8 percent to develop acute kidney damage.

- Cumulative risk of 1.7 percent to develop kidney failure.

The researchers separated the patients who were taking non-vitamin K antagonist oral anticoagulants from those who were taking warfarin.They found that those patients had reduced risk of developing adverse kidney outcomes.

"Patients with atrial fibrillation already face a high risk of kidney disease, perhaps because many such patients have risk factors, such as advanced age, diabetes, and hypertension.Many drugs these patients are taking rely on kidney function for drug elimination.Therefore, it is particularly important for these patients to choose a drug that minimizes the impact on kidneys," said Dr.Yao.

According to Dr.Peter Noseworthy, a cardiologist at Mayo Clinic, their findings have an important connection to medical practice.Along with Dr.Yao, Dr.Noseworthy urged healthcare providers to make efforts to reduce the risk of kidney decline and damage in patients using anticoagulants.Patients under anticoagulants should never stop or change their medications without consulting their doctors.

Atrial Fibrillation

An estimated 33.5 million people in the world suffer from atrial fibrillation in 2010, with 20.9 million men and 12.6 million women.The prevalence rate of AF is 596 per 100,000 people in men, while 373 per 100,000 people in women.

Symptoms of atrial fibrillation include palpitations, weakness, fatigue, dizziness, shortness of breath, and chest pain.Some people, however, do not present any clinical symptoms, and are usually unaware of the problem unless revealed by a medical exam.

1.Occasional AF has symptoms that last for a few minutes to hours.These symptoms usually stop on their own.

2.Persistent AF has symptoms that do not stop on their own and require medical attention.It needs specific treatments, such as electrical shock, to restore the normal heart rhythm.

3.Long-standing persistent AF has symptoms that last longer than a year.

4.Permanent AF has a clinical presentation of a permanent abnormal heartbeat.It cannot be restored and the patient must be under medication to control it.

Causes of AF include hypertension, heart attacks, abnormalities in the heart valves, defects in the heart since birth, hormonal or metabolic imbalance, and exposure to certain chemicals such as caffeine, alcohol, and tobacco.Stroke and heart failure are the most common complications of AF.

- The abnormal rhythm of the heart can cause the blood to accumulate in the heart's upper chambers.The accumulate blood forms clots and if they break away, the clots can travel to the brain, causing a stroke.

- The abnormal rhythm can also weaken the heart and eventually result in heart failure.

There are preventive measures to reduce the risk of developing heart diseases such as atrial fibrillation, include consistent exercise, avoid unhealthy lifestyle habits, maintain a healthy weight, eat a healthy diet, and manage stress.

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