[Atrial fibrillation, oral anticoagulation and nephroprotection: caution or bravery?]

Abstract

Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related and share several risk factors (i.e. hypertension, diabetes mellitus, congestive heart failure). As consequence, AF is very common among CKD patients, especially in those with end stage renal disease (ESRD). Moreover, patients with AF and advanced kidney disease have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. The adequate long-term oral anticoagulation in this subgroup of patients represents a major challenging issue faced by physicians in clinical practice. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD while vitamin K antagonists (VKAs) are characterized by a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.

• Authors: Luca Di Lullo, Michele Magnocavallo, Giampaolo Vetta, Carlo Lavalle, Vincenzo Barbera, Claudio Ronco, Ernesto Paoletti, Maura Ravera, Maria Fusaro, Domenico Russo, Antonio De Pascalis, Antonio Bellasi
• Journal: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia (G Ital Nefrol) Vol. 39 Issue 2 (Apr 21 2022) ISSN: 1724-5990 [Electronic] Italy
• PMID: 35470995 (Publication Type: Journal Article, Review)
• Copyright: Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

Chemical References

• Anticoagulants

Topics

• Administration, Oral
• Anticoagulants (adverse effects)
• Atrial Fibrillation (complications, drug therapy)
• Courage
• Female
• Humans
• Kidney Failure, Chronic (chemically induced)
• Male
• Renal Insufficiency, Chronic (drug therapy)
• Stroke (etiology, prevention & control)