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Oral anticoagulation in chronic kidney disease with atrial fibrillation

Pablo Gomez-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, Spain.

Nefrologia
|September 27, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) are effective and safe for patients with chronic kidney disease (CKD) and atrial fibrillation (AF), showing benefits over vitamin K antagonists (VKAs), especially in advanced CKD stages.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist, increasing risks of cardiovascular events and mortality.
  • Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are used for stroke prevention in AF patients.
  • Evidence for DOACs and VKAs in advanced CKD is limited.

Purpose of the Study:

  • To review the association between CKD and AF.
  • To evaluate the efficacy and safety of DOACs and VKAs in CKD patients with AF.
  • To compare renal effects of DOACs versus warfarin.

Main Methods:

  • Review of epidemiological and pathophysiological data.
  • Analysis of randomized trials and observational studies on DOACs and VKAs in CKD stages.
  • Comparison of efficacy, safety, and renal outcomes.

Main Results:

  • In CKD stage 3 non-valvular AF, DOACs show equal or greater efficacy and safety than VKAs for stroke prevention.
  • Observational studies suggest DOACs may lower risks of acute kidney injury and CKD progression compared to warfarin.
  • Limited randomized trial data exists for DOACs/VKAs in advanced CKD.

Conclusions:

  • DOACs represent a safe and effective option for stroke prevention in AF patients across various CKD stages.
  • DOACs may offer renal protective benefits compared to warfarin in CKD patients with AF.
  • Further research is needed for DOACs and VKAs in advanced CKD.

Keywords:
Antagonistas de 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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