Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease

2019 ◽  
Vol 42 (11) ◽  
pp. 1463-1470 ◽  
Author(s):  
Harpreet S. Bhatia ◽  
Joseph Bailey ◽  
Ozan Unlu ◽  
Katherine Hoffman ◽  
Robert J. Kim
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Efficacy And Safety

Warfarin Dosing and Outcomes in Chronic Kidney Disease: A Closer Look at Warfarin Disposition

2019 ◽  
Vol 20 (8) ◽  
pp. 633-645
Author(s):  
Osama Y. Alshogran
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Cardiovascular Complications ◽  
Efficacy And Safety ◽  
Review Of Literature ◽  
Growing Body ◽  
Warfarin Dosing

Background: Chronic Kidney Disease (CKD) is a prevalent worldwide health problem. Patients with CKD are more prone to developing cardiovascular complications such as atrial fibrillation and stroke. This warrants the use of oral anticoagulants, such as warfarin, in this population. While the efficacy and safety of warfarin in this setting remain controversial, a growing body of evidence emphasizes that warfarin use in CKD can be problematic. This review discusses 1) warfarin use, dosing and outcomes in CKD patients; and 2) possible pharmacokinetic mechanisms for altered warfarin dosing and response in CKD. Methods: Structured search and review of literature articles evaluating warfarin dosing and outcomes in CKD. Data and information about warfarin metabolism, transport, and pharmacokinetics in CKD were also analyzed and summarized. Results: The literature data suggest that changes in warfarin pharmacokinetics such as protein binding, nonrenal clearance, the disposition of warfarin metabolites may partially contribute to altered warfarin dosing and response in CKD. Conclusion: Although the evidence to support warfarin use in advanced CKD is still unclear, this synthesis of previous findings may help in improving optimized warfarin therapy in CKD settings.

Safety and Efficacy of Direct Oral Anticoagulants Versus Warfarin in Patients With Chronic Kidney Disease and Atrial Fibrillation

2020 ◽  
Vol 125 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Amber Makani ◽  
Samir Saba ◽  
Sandeep K. Jain ◽  
Aditya Bhonsale ◽  
Michael S. Sharbaugh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Safety And Efficacy

scholarly journals Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Renal Dysfunction

2021 ◽  
Vol 17 (1) ◽  
pp. 62-72
Author(s):  
Z. D. Kobalava ◽  
A. A. Shavarov ◽  
M. V. Vatsik-Gorodetskaya
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Dysfunction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Disease Epidemiology ◽  
Increased Risk ◽  
Estimate Glomerular Filtration Rate

Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.

scholarly journals Specifics of anticoagulation in combination with atrial fibrillation and chronic kidney disease

2021 ◽  
Vol 26 (3S) ◽  
pp. 4676
Author(s):  
N. Sh. Zagidullin ◽  
P. A. Davtyan
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Population Aging ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cardiovascular Death

Due to the population aging and the accumulation of concomitant diseases, the prevalence of atrial fibrillation (AF) as the most common arrhythmia is increasing. On the other hand, 14% of the population has chronic kidney disease (CKD). These conditions are often combined with each other causing a prothrombogenic effect, which significantly increase the number of unfavorable outcomes such as thromboembolism, stroke, myocardial infarction and cardiovascular death. This is especially true for the last stages of CKD, the so-called end-stage renal disease with a glomerular filtration rate <29 ml/min/1,73 m2. Previously, the vitamin K antagonist warfarin was the central drug for anticoagulant therapy of AF + CKD combination, but in the last decade, direct oral anticoagulants became widely used. This article discusses the evidence base for using each of the anticoagulants in patients with AF+CKD combination compared with warfarin, including depending on the severity of glomerular filtration rate decrease.

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