Anticoagulant Treatment in Patients with Atrial Fibrillation and Chronic Kidney Disease

Abstract

Aim: To investigate the efficacy and safety profile of oral anticoagulants and determine the best treatment for patients with atrial fibrillation (AF) and chronic kidney disease (CKD ). Methods and materials: A systematic assessment of literature from Pubmed/MEDLINE was performed in search of studies evaluating the efficacy, safety, pharmacokinetics, and pharmacodynamics of direct oral anticoagulants (DOACs) and warfarin in patients with CKD . Results: According to guidelines, DOACs are the treatment of choice for patients with CKD 1–3 (Crcl ≥ 30 mL/min) due to their high efficacy, better safety profile, and fewer food/drug and drug/ drug interactions than warfarin. For patients with CKD 4 (Crcl 15-29 mL/min), there are no such strong recommendations as to which group of anticoagulants is the better choice, and for those with CKD 5 (Crcl <15 mL/min), the choice is currently narrowed to warfarin or apixaban. However, there seem to be more negative effects of warfarin, including accelerated CKD progression and increased risk of bleeding compared to DOACs. Conclusion: Considering their superior safety profile and the possibility of apixaban, rivaroxaban, and edoxaban to achieve an adequate anticoagulant effect even in severe kidney disease, DOACs seem to be a better option for anticoagulant treatment of patients with AF and CKD .

Keywords

• Atrial fibrillation
• Anticoagulant treatment
• Chronic kidney disease