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Anticoagulation in atrial fibrillation and co-existent chronic kidney disease: efficacy versus safety

Imtiaz Salim1, Jassim Al Suwaidi, Wissam Ghadban

  • 1Hamad Medical Corp., Doha, Qatar.

Expert Opinion on Drug Safety
|October 26, 2012
PubMed

Insights

Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) face increased stroke risk. Warfarin anticoagulation is key for stroke prevention in CKD patients, but newer agents need further study.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) have a higher stroke incidence.
  • AF prevalence has increased in CKD patients over the past two decades.
  • Warfarin's safety and efficacy in severe CKD for AF stroke prevention remain under-documented.

Purpose of the Study:

  • To review the risks and benefits of long-term anticoagulation in AF patients with CKD.
  • To explore the role of novel anticoagulant agents in this patient population.

Main Methods:

  • A Medline literature search was conducted from 1980 to 2012.
  • Keywords included 'chronic kidney disease,' 'atrial fibrillation,' 'hemodialysis,' 'warfarin,' 'anticoagulation,' and 'new oral anticoagulants.'

Main Results:

  • Long-term warfarin anticoagulation with monitoring is considered essential for stroke prevention in CKD patients.
  • Evidence on newer agents in this population is limited.

Conclusions:

  • Warfarin is the current cornerstone for stroke prevention in CKD patients with AF.
  • Further research is needed to evaluate newer anticoagulants for safety and efficacy in this high-risk group to reduce stroke incidence.
Abstract

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