Key result
Direct oral anticoagulants require dose adjustment for renal function in patients with atrial fibrillation, with ongoing debate over the best equation to estimate glomerular filtration rate.
Why the study?
Atrial fibrillation and renal dysfunction often coexist with increased thromboembolic risk, prompting the need to evaluate arguments for the benefit of direct oral anticoagulants in this population.
Do direct oral anticoagulants benefit patients with atrial fibrillation and renal dysfunction?
Do direct oral anticoagulants benefit patients with atrial fibrillation and renal dysfunction?
This review highlights the need for careful dose adjustment of direct oral anticoagulants based on renal function in patients with atrial fibrillation and chronic kidney disease.
Requires careful DOAC dosing by renal function in AF; leaves open optimal GFR estimation equation.
Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.
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Kobalava et al. (2021) conducted a review in Atrial fibrillation and renal dysfunction. Direct oral anticoagulants was evaluated. Direct oral anticoagulants require dose adjustment for renal function in patients with atrial fibrillation, with ongoing debate over the best equation to estimate glomerular filtration rate.
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