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Oral anticoagulation in chronic kidney disease with atrial fibrillation

Pablo Gómez-Fernández1, Antonio Martín Santana2, Juan de Dios Arjona Barrionuevo3

  • 1Unidad de Factores de Riesgo Vascular, Servicio de Nefrología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España.

Nefrologia
|December 14, 2020
PubMed

Insights

Direct oral anticoagulants (DOACs) are effective and safe for patients with chronic kidney disease (CKD) stage 3 and non-valvular atrial fibrillation (AF). Observational data suggest DOACs may also reduce kidney damage compared to warfarin.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist, increasing risks of cardiovascular events and mortality.
  • In non-valvular AF patients with CKD stage 3, direct oral anticoagulants (DOACs) demonstrate comparable or superior efficacy and improved safety over vitamin K antagonists (VKAs) for stroke prevention.

Purpose of the Study:

  • To review the association between CKD and AF, including epidemiological and pathophysiological aspects.
  • To evaluate the efficacy and safety of warfarin and DOACs across different CKD stages in AF patients.
  • To compare warfarin and DOACs regarding efficacy, anticoagulant safety, and renal effects.

Main Methods:

  • Review of epidemiological and pathophysiological data on CKD and AF.
  • Analysis of evidence from randomized trials and observational studies on anticoagulants in CKD patients with AF.
  • Comparative assessment of warfarin versus DOACs in terms of clinical outcomes and renal impact.

Main Results:

  • DOACs show equal or greater efficacy and better safety than VKAs in CKD stage 3 non-valvular AF patients.
  • Observational studies indicate DOACs may lower the risk of acute kidney injury and CKD progression compared to warfarin.
  • Limited randomized trial data exists for DOACs versus VKAs in advanced CKD.

Conclusions:

  • DOACs represent a viable and potentially safer alternative to VKAs for stroke prevention in non-valvular AF patients with CKD stage 3.
  • Further research, particularly randomized trials, is needed to establish definitive recommendations for DOACs in advanced CKD stages.
  • DOACs may offer renal protective benefits, warranting further investigation in the context of AF management in CKD patients.

Keywords:
Antagonistas de la vitamina KAnticoagulant-related nephropathyAnticoagulantes orales de acción directaAtrial fibrillationChronic kidney diseaseDirect-acting oral anticoagulantsEnfermedad renal crónicaFibrilación auricularNefropatía por anticoagulantesVitamin K antagonist

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