Management of anticoagulation in patients with atrial fibrillation and renal dysfunction: A systematic review

BACKGROUND Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity and mortality, particularly in patients with concomitant renal dysfunction. Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk. AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population, ensuring optimal outcomes. METHODS The present review followed PRISMA guidelines. Data extraction was conducted using a standardized template that captured key study characteristics: Population demographics, renal function metrics, anticoagulant dosing strategies, and primary and secondary outcomes. For quality assessment, we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials. Observational studies were appraised using the Newcastle-Ottawa Scale. RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies, balancing thrombotic and bleeding risks. Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease, emphasizing the importance of individualized therapy. CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.