Anticoagulation Strategies for Atrial Fibrillation in CKD Stage G5 and Dialysis Patients: An Updated Scoping Review

Reviews in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 26(3)

Published: March 5, 2025

Clinical trials of direct oral anticoagulants (DOACs) often exclude patients with advanced chronic kidney disease (CKD), creating uncertainty regarding their safety and efficacy compared warfarin. This study addresses this gap by providing key insights into anticoagulation in high-risk population. evaluated the effectiveness DOACs to warfarin no therapy atrial fibrillation (AF) CKD stage G5 or on dialysis. scoping review followed a six-stage framework Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) guidelines. An exhaustive search four databases identified relevant papers published through August 2024. The data extraction process was conducted independently, subsequent qualitative quantitative analyses conducted. Among 33 studies included final analysis, DOACs, particularly apixaban, were associated 20-30% decreased major bleeding risk Stroke incidence comparable between vitamin K antagonists (VKAs), apixaban showing improved prevention severe CKD. Observational reported slightly lower mortality rates including fewer cardiovascular-related deaths than VKAs. rivaroxaban, demonstrate favorable profile warfarin, but show inconsistent evidence balancing thromboembolic risks AF Future should focus optimizing dosing strategies evaluating long-term efficacy.

Language: Английский

Epigenetic Biomarkers in Thrombophilia-Related Pregnancy Complications: Mechanisms, Diagnostic Potential, and Therapeutic Implications: A Narrative Review

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(24), P. 13634 - 13634

Published: Dec. 20, 2024

Pregnancy complications associated with thrombophilia represent significant risks for maternal and fetal health, leading to adverse outcomes such as pre-eclampsia, recurrent pregnancy loss, intra-uterine growth restriction (IUGR). They are caused by disruptions in key physiological processes, including the coagulation cascade, trophoblast invasion, angiogenesis, immune control. Recent advancements epigenetics have revealed that non-coding RNAs, especially microRNAs (miRNAs), long RNAs (lncRNAs), extracellular vesicles (EVs) carrying these play crucial roles regulation of biological processes. This review aims identify epigenetic biomarkers best candidates evaluating thrombophilia-related assessing efficacy anticoagulant antiaggregant therapies. We emphasize their potential integration into personalized treatment plans, aiming improve risk assessment therapy strategies thrombophilic pregnancies. Future research should focus on validating establishing standardized protocols enable clinical practice, paving way a precision medicine approach obstetric care.

Language: Английский