Key result
Non-vitamin K antagonist oral anticoagulants (NOACs) are associated with slower deterioration of renal function compared to Vitamin K antagonists in patients with atrial fibrillation and CKD.
Why the study?
Choosing the appropriate oral anticoagulant therapy in patients with AF and CKD is challenging, as deterioration of renal function is common and not all agents affect the kidneys equally.
Do NOACs compared to VKAs reduce the deterioration of renal function in patients with atrial fibrillation and chronic kidney disease?
Do NOACs compared to VKAs reduce the deterioration of renal function in patients with atrial fibrillation and chronic kidney disease?
NOACs should be preferred over VKAs in eligible patients with AF and CKD due to their association with slower deterioration of renal function.
May support NOAC preference in AF-CKD to slow renal decline; leaves open need for randomized confirmation.
INTRODUCTION: Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related. These diseases share common risk factors and are associated with increased risk of thromboembolic events. Choosing the appropriate oral anticoagulant therapy (OAC) in patients with AF and CKD is challenging. Deterioration of renal function is common in patients with AF treated with OACs, although not all OACs affect the kidneys equally. AREAS COVERED: In this review, we aim to summarize the current knowledge of the prevention of thromboembolic events in patients with AF and CKD, focusing on the impact of specific OAC agents on renal function. EXPERT OPINION: Consideration of OAC use is mandatory in patients with AF and CKD who are at increased risk of stroke or systemic embolism. Available evidence suggests that the use of non-vitamin K antagonist oral anticoagulants (NOACs) is associated with slower deterioration of renal function in comparison to Vitamin K antagonists (VKAs). Hence, a NOAC should be used in preference to VKAs in all NOAC-eligible patients with AF and CKD. Regarding patients with end-stage renal dysfunction and those on dialysis or renal replacement therapy, the use of NOAC should be considered in line with locally relevant formal recommendations.
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Šimić et al. (2023) conducted a review in Atrial fibrillation and chronic kidney disease. Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Deterioration of renal function. Non-vitamin K antagonist oral anticoagulants (NOACs) are associated with slower deterioration of renal function compared to Vitamin K antagonists in patients with atrial fibrillation and CKD.
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