Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with advanced chronic kidney and liver diseases

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  Figure 1. Regular follow-up of renal functions is recommended in patients with impaired renal functions (upper panel). Subgroup analyses from landmark trials of NOACs observed no increase in major bleeding with NOACs even with declining CrCl rates. There are still knowledge gaps for patients with a CrCl rate <15 mL/min. The Child-Pugh score is recommended to stratify patients with different severity of liver function impairment and to choose appropriate NOACs (lower panel). Regular monitoring of liver functions should be done in patients receiving NOACs. *Data presented in the figure were adopted from the original analysis and sub-analysis of RCTs (ARISTOTLE, ENGAGE AF-TIMI 48, RE-LY, ROCKET AF).7–10, 24–28 &CrCl 25-50 mL/min in ARISTOTLE trial; #CrCl 50-95 mL/min in ENGAGE AF-TIMI trial; □CrCl 25-29 mL/min; $except rivaroxaban. AF, atrial fibrillation; CI, confidence interval; CrCl, creatinine clearance, mL/min; HR, hazard ratio; NOACs, non-vitamin K antagonist oral anticoagulants; RCTs, randomized controlled trials.