Key result
AF affects ~20% of advanced CKD patients, complicating anticoagulation due to DOAC contraindications in ESRD.
Why the study?
DOACs are currently contraindicated in ESRD, while VKAs present critical issues including a narrow therapeutic window and unfavorable risk/benefit ratio, prompting a review of DOAC applications in CKD and ESRD.
Does DOAC therapy improve outcomes compared to VKAs in atrial fibrillation patients with chronic kidney disease, especially end stage renal disease?
Does DOAC therapy improve outcomes compared to VKAs in atrial fibrillation patients with chronic kidney disease, especially end stage renal disease?
This review highlights the critical need to evaluate DOAC therapy in AF patients with advanced CKD/ESRD, given the significant limitations and bleeding risks associated with VKA use in this population.
High AF burden in advanced CKD complicates anticoagulation choices; leaves open optimal therapy evaluation in ESRD beyond current VKA limitations.
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
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Magnocavallo et al. (2020) conducted a review in Atrial fibrillation and chronic kidney disease. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated. Atrial fibrillation prevalence ranges between 15% and 20% in advanced chronic kidney disease, complicating anticoagulation since DOACs are contraindicated in end-stage renal disease.
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