Key result
While NOACs are effective in mild-to-moderate chronic kidney disease, warfarin remains the preferred anticoagulant for stroke prevention in atrial fibrillation patients with severe or end-stage renal disease due to a lack of randomized trial data.
Why the study?
While NOACs are effective in mild-to-moderate renal dysfunction, data are scarce regarding their efficacy and safety in severe and end-stage renal dysfunction.
Do non-vitamin K antagonist oral anticoagulants prevent stroke and systemic embolism safely in patients with atrial fibrillation and severe or end-stage renal disease?
Do non-vitamin K antagonist oral anticoagulants prevent stroke and systemic embolism safely in patients with atrial fibrillation and severe or end-stage renal disease?
While NOACs are effective and safe in mild-to-moderate CKD, warfarin remains the preferred anticoagulant for stroke prevention in AF patients with end-stage renal disease due to a lack of prospective clinical trials and concerns over bleeding risk.
Bidirectional AF-CKD link and elevated risks in observational data; leaves open optimal anticoagulation strategies for this population.
Atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, particularly with increasing of age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between AF and CKD seems to be bidirectional. CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of stroke, mortality, cardiac events, and bleeding. Stroke prevention requires use of oral anticoagulants, which are either vitamin K antagonists (e.g. warfarin), or the non-vitamin K antagonist oral anticoagulants (NOAC). While NOAC have been shown to be effective in mild-to-moderate renal dysfunction, there are a paucity of data regarding NOAC in severe and end-stage renal dysfunction. The followingwill discuss the evidence for NOAC in CKD, and summarize the current knowledge regarding the efficacy and safety of NOAC to prevent AF-related stroke and systemic embolism in severe and end-stage renal disease.
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Budi Yuli Setianto (2019) conducted a review in Atrial fibrillation and chronic kidney disease. Non-vitamin K antagonist oral anticoagulants (NOAC) vs. Vitamin K antagonists (e.g., warfarin) was evaluated. While NOACs are effective in mild-to-moderate chronic kidney disease, warfarin remains the preferred anticoagulant for stroke prevention in atrial fibrillation patients with severe or end-stage renal disease due to a lack of randomized trial data.
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