open access

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Review paper
Published online: 2019-03-08
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The use of anticoagulants in chronic kidney disease: Common point of view of cardiologists and nephrologists

Justyna Domienik-Karłowicz, Olga Tronina, Wojciech Lisik, Magdalena Durlik, Piotr Pruszczyk
DOI: 10.5603/CJ.a2019.0025
·
Pubmed: 30912573

open access

Ahead of print
Review articles
Published online: 2019-03-08

Abstract

In patients diagnosed with chronic kidney disease (CKD), atrial fibrillation (AF) is associated with an increased risk of thromboembolism and stroke. Moreover, patients with CKD — especially those in end-stage renal disease — also present an increased risk of bleeding. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF and an increased risk of stroke. However, the underuse of these drugs was observed, mainly due to safety reasons and restricted evidence on efficacy. Much evidence suggests that non-vitamin K-dependent oral anticoagulant agents significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonists, such as warfarin, in normal renal function subjects. Thus, they are currently recommended for that group of patients. However, their metabolism is largely dependent on the kidneys for elimination, and current knowledge in this area is limited due to patients with a decreased glomerular filtration rate are usually excluded from clinical trials. The present review article focuses on currently available data on oral anticoagulants in patients with moderate to advanced chronic kidney disease and those with end stage renal disease.

Abstract

In patients diagnosed with chronic kidney disease (CKD), atrial fibrillation (AF) is associated with an increased risk of thromboembolism and stroke. Moreover, patients with CKD — especially those in end-stage renal disease — also present an increased risk of bleeding. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF and an increased risk of stroke. However, the underuse of these drugs was observed, mainly due to safety reasons and restricted evidence on efficacy. Much evidence suggests that non-vitamin K-dependent oral anticoagulant agents significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonists, such as warfarin, in normal renal function subjects. Thus, they are currently recommended for that group of patients. However, their metabolism is largely dependent on the kidneys for elimination, and current knowledge in this area is limited due to patients with a decreased glomerular filtration rate are usually excluded from clinical trials. The present review article focuses on currently available data on oral anticoagulants in patients with moderate to advanced chronic kidney disease and those with end stage renal disease.

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Keywords

anticoagulation therapy, atrial fibrillation, chronic kidney disease, non-vitamin K-dependent oral anticoagulants, warfarin

About this article
Title

The use of anticoagulants in chronic kidney disease: Common point of view of cardiologists and nephrologists

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Review paper

Published online

2019-03-08

DOI

10.5603/CJ.a2019.0025

Pubmed

30912573

Keywords

anticoagulation therapy
atrial fibrillation
chronic kidney disease
non-vitamin K-dependent oral anticoagulants
warfarin

Authors

Justyna Domienik-Karłowicz
Olga Tronina
Wojciech Lisik
Magdalena Durlik
Piotr Pruszczyk

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