Key result
Direct oral anticoagulants demonstrate comparable or superior efficacy and safety compared to warfarin in patients with atrial fibrillation and mild to moderate chronic kidney disease, though data for severe renal impairment remains limited.
Why the study?
AF and CKD are interrelated conditions associated with poor prognosis, and the efficacy and safety of DOACs may depend on renal function due to drug pharmacokinetics.
Does DOAC therapy compared to warfarin improve outcomes in patients with atrial fibrillation and renal dysfunction?
Does DOAC therapy compared to warfarin improve outcomes in patients with atrial fibrillation and renal dysfunction?
This review summarizes current evidence and international guidelines on the use of DOACs versus warfarin in patients with atrial fibrillation and varying stages of renal dysfunction.
Answers are grounded in this paper and cite their sources.
Renal assessment critical for DOAC dosing in AF-CKD; leaves optimal strategies open for prospective trials.
Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and interrelated diseases, the combination of which is associated with a poor prognosis. The efficacy and safety of direct oral anticoagulants (DOACs) used to prevent thromboembolic complications of AF may depend on renal function due to the specific pharmacokinetics of these drugs. This review considers current data on the role of kidneys in the pathogenesis of ischemic and bleeding events, methods of renal function assessment and related classification issues, as well as comparison of warfarin and DOAC therapy, in patients with AF and renal dysfunction of different stages based on the results of randomized controlled trials and actual clinical practice. DOAC use in the context of dynamic deterioration of renal function, supranormal renal function, and their effect on renal outcomes is discussed. International guidelines on anticoagulant therapy in AF and renal dysfunction were analyzed.
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Кобалава et al. (2020) conducted a review in Atrial fibrillation and chronic kidney disease. Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated. Direct oral anticoagulants demonstrate comparable or superior efficacy and safety compared to warfarin in patients with atrial fibrillation and mild to moderate chronic kidney disease, though data for severe renal impairment remains limited.
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