scholarly journals Renal Function Protection as an Important Component of a Comprehensive Approach to the Management of Patients with Atrial Fibrillation

2022 ◽  
Vol 17 (6) ◽  
pp. 916-926
Author(s):  
T. V. Pavlova
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Warfarin Therapy ◽  
Integrated Approach ◽  
Cardiovascular Complications ◽  
Hemorrhagic Events ◽  
High Incidence ◽  
Coronary Events ◽  
Positive Effect ◽  
Single Dosing

The increase in the life expectancy of the population  is accompanied by an increase in the prevalence of diseases for which old and senile age are risk factors. Atrial fibrillation (AF) and chronic kidney disease (CKD) are two diseases that can coexist in a patient. The risk of ac thromboembolic and hemorrhagic events in this case increases due to the mutual aggravating influence of these diseases. In addition,  these patients have a high incidence of coronary  events, and cardiovascular complications are the main cause of death in patients with AF and CKD. Consequently, such patients require an integrated  approach  to treatment,  and their management is a complex  clinical task. The direct oral anticoagulant rivaroxaban has been most studied in a population  of comorbid  AF and CKD  patients and has proven a high efficacy and safety profile in these patients in randomized controlled trials. In addition,  rivaroxaban has shown  a significant  reduction in the risk of myocardial  infarction  in various patients,  as well as the possibility of preserving renal function to a greater extent compared  with warfarin therapy, and a possible positive effect on reducing  the risk of cognitive impairment.  A single dosing  regimen  can improve adherence  to treatment,  which is one of the key conditions  for achieving  the above effects. Thus, these factors make it possible to achieve comprehensive protection of comorbid  patients with AF and CKD.

scholarly journals Whether Warfarin Therapy is Associated with Damage on Renal Function in Chinese Patients with Nonvalvular Atrial Fibrillation

2016 ◽  
Vol 129 (10) ◽  
pp. 1135-1139 ◽  
Author(s):  
Yu Kong ◽  
Xin Du ◽  
Ri-Bo Tang ◽  
Ting Zhang ◽  
Xue-Yuan Guo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Warfarin Therapy ◽  
Chinese Patients ◽  
Nonvalvular Atrial Fibrillation

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.

CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

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