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Nonvitamin K Oral Anticoagulants in Patients With Atrial Fibrillation and Severe Renal Dysfunction

Maria Mahmood1, Gregory Y H Lip2

  • 1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.

Revista Espanola De Cardiologia (English Ed.)
|July 1, 2018
PubMed

Insights

Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist. This review examines non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in CKD patients, focusing on those with severe or end-stage renal disease.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) and chronic kidney disease (CKD) are prevalent, particularly in aging populations with comorbidities.
  • A bidirectional relationship exists between AF and CKD, with each condition potentially worsening the other.
  • CKD patients with AF face elevated risks of stroke, mortality, cardiac events, and bleeding.

Purpose of the Study:

  • To review the evidence for non-vitamin K antagonist oral anticoagulants (NOACs) in patients with chronic kidney disease (CKD).
  • To summarize current knowledge on the efficacy and safety of NOACs for preventing AF-related stroke and systemic embolism in severe and end-stage renal disease.

Main Methods:

  • Literature review of studies investigating NOACs in patients with varying degrees of renal dysfunction.
  • Analysis of data on stroke prevention, systemic embolism, and bleeding events associated with NOAC use in CKD.

Main Results:

  • NOACs demonstrate efficacy in mild-to-moderate renal dysfunction.
  • Limited data currently exists on NOAC use in severe and end-stage renal disease.
  • Further research is needed to establish optimal NOAC use in advanced CKD stages.

Conclusions:

  • Stroke prevention in AF patients with CKD is crucial.
  • The role of NOACs in severe and end-stage renal disease requires further investigation.
  • Evidence-based guidelines are needed for NOAC prescription in advanced CKD.

Keywords:
Anticoagulantes orales no dependientes de la vitamina KAtrial fibrillationChronic kidney diseaseEnfermedad renal crónicaFibrilación auricularNonvitamin K antagonist oral anticoagulants

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