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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Use of oral anticoagulants in patients with atrial fibrillation and renal dysfunction

Tatjana S Potpara1,2, Charles J Ferro3, Gregory Y H Lip1,3,4

  • 1School of Medicine, Belgrade University, Belgrade, Serbia.

Nature Reviews. Nephrology
|March 27, 2018
PubMed

Insights

Atrial fibrillation (AF) and chronic kidney disease (CKD) share risk factors and worsen each other. Non-vitamin K antagonist oral anticoagulants (NOACs) are effective for mild-to-moderate CKD, but management for severe CKD remains challenging.

Area of Science:

  • Cardiology
  • Nephrology

Background:

  • Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and interconnected conditions.
  • Shared risk factors include older age, hypertension, and diabetes mellitus.
  • CKD increases AF risk, while AF can lead to CKD development or progression.

Purpose of the Study:

  • To review the efficacy and safety of anticoagulants in patients with AF and CKD.
  • To highlight the challenges in managing patients with AF and severe CKD or end-stage renal disease on dialysis.

Main Methods:

  • Analysis of data from randomized clinical trials comparing NOACs and warfarin in AF patients with varying degrees of CKD.
  • Review of observational cohort studies concerning anticoagulation in advanced CKD.

Main Results:

  • NOACs demonstrated similar efficacy and safety to warfarin in AF patients with mild-to-moderate CKD, requiring dose adjustments.
  • Evidence for managing AF patients with severe CKD or on dialysis is limited, with conflicting results from observational studies.
  • Patients with advanced CKD have increased thromboembolic and bleeding risks.

Conclusions:

  • NOACs are a viable option for AF patients with mild-to-moderate CKD when dosed appropriately.
  • Management of AF in severe CKD or end-stage renal disease necessitates careful risk-benefit assessment, potentially involving warfarin with close monitoring.

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