open access

Vol 12, No 1 (2017)
Review paper
Published online: 2017-03-03
Get Citation

Prophylaxis of thromboembolic complications in patients with atrial fibrillation and chronic kidney disease — role of new oral anticoagulants

Michalina Katarzyna Zagańczyk, Iwona Gorczyca-Michta, Andrzej Jaroszyński, Beata Wożakowska-Kapłon
DOI: 10.5603/FC.2017.0007
·
Folia Cardiologica 2017;12(1):68-77.

open access

Vol 12, No 1 (2017)
Review Papers
Published online: 2017-03-03

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the general population. Chronic kidney disease (CKD) is a risk factor for AF and its occurrence strongly influences the choice of medicines in the prevention of thromboembolism in patients with this arrhythmia. Evaluation of kidney function is essential before starting anticoagulant therapy as well as during it. Among patients in G3 stage of CKD the medicaments of the first choice are considered to be apixaban 5 mg twice daily, rivaroxaban 15 mg once daily and edoxaban 30 mg once daily. Vitamin K antagonists are designed for patients with AF regardless of the stage of CKD; these are also dedicated to patients on dialysis. In patients with CKD the balance of benefits and risks of anticoagulation should be carefully considered, in particular among patients on the hemodialysis due to the use of heparin during the procedure. Recent reports on the use of new oral anticoagulants might expand the indications for using these medicines in CKD patients.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the general population. Chronic kidney disease (CKD) is a risk factor for AF and its occurrence strongly influences the choice of medicines in the prevention of thromboembolism in patients with this arrhythmia. Evaluation of kidney function is essential before starting anticoagulant therapy as well as during it. Among patients in G3 stage of CKD the medicaments of the first choice are considered to be apixaban 5 mg twice daily, rivaroxaban 15 mg once daily and edoxaban 30 mg once daily. Vitamin K antagonists are designed for patients with AF regardless of the stage of CKD; these are also dedicated to patients on dialysis. In patients with CKD the balance of benefits and risks of anticoagulation should be carefully considered, in particular among patients on the hemodialysis due to the use of heparin during the procedure. Recent reports on the use of new oral anticoagulants might expand the indications for using these medicines in CKD patients.

Get Citation

Keywords

anticoagulants, chronic kidney disease, atrial fibrillation, rivaroxaban, apixaban, dabigatran, edoxaban

About this article
Title

Prophylaxis of thromboembolic complications in patients with atrial fibrillation and chronic kidney disease — role of new oral anticoagulants

Journal

Folia Cardiologica

Issue

Vol 12, No 1 (2017)

Article type

Review paper

Pages

68-77

Published online

2017-03-03

DOI

10.5603/FC.2017.0007

Bibliographic record

Folia Cardiologica 2017;12(1):68-77.

Keywords

anticoagulants
chronic kidney disease
atrial fibrillation
rivaroxaban
apixaban
dabigatran
edoxaban

Authors

Michalina Katarzyna Zagańczyk
Iwona Gorczyca-Michta
Andrzej Jaroszyński
Beata Wożakowska-Kapłon

References (50)
  1. Dąbrowski P, Mizia-Stec K, Stec J. Migotanie przedsionków a przewlekła choroba nerek. Kardiol Pol. 2011; 69: 167–172.
  2. Młodawska E, Tomaszuk-Kazberuk A, Łopatowska P, et al. Management of patients with atrial fibrillation and chronic kidney disease in light of the latest guidelines. Pol Arch Med Wewn. 2016; 126(5): 353–362.
  3. Duda B, Szufladowicz E, Jedynak Z, et al. Migotanie przedsionków a choroby nerek, Forum Medycyny Rodzinnej. 2009; 3: 213–221.
  4. Acar G, Akçay A, Doğan E, et al. The prevalence and predictors of atrial fibrillation in hemodialysis patients. Turk Kardiyol Dern Ars. 2010; 38(1): 8–13.
  5. Voroneanu L, Covic A. Arrhythmias in hemodialysis patients. J Nephrol. 2009; 22(6): 716–725.
  6. Di Lullo L, Gorini A, Russo D, et al. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. Cardiorenal Med. 2015; 5(4): 254–266.
  7. Undas A, Nycz K, Pastuszczak M, et al. The effect of chronic kidney disease on fibrin clot properties in patients with acute coronary syndrome. Blood Coagul Fibrinolysis. 2010; 21(6): 522–527.
  8. Zimmerman D, Sood MM, Rigatto C, et al. Systematic review and meta-analysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis. Nephrol Dial Transplant. 2012; 27(10): 3816–3822.
  9. Lane DA, Lip GYH. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012; 126(7): 860–865.
  10. Januszkiewicz Ł. Skala ATRIA pozwala dokładniej przewidzieć powikłania zakrzepowo zatorowe niż skale CHADS2 i CHA2DS2-VASc. Available on: http://www.ptkardio.pl. Data access December 10, 2013.
  11. Piccini JP, Stevens SR, Chang Y, et al. Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation. 2013; 127(2): 224–232.
  12. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  13. Lane DA, Aguinaga L, Blomström-Lundqvist C, et al. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace. 2015; 17(12): 1747–1769.
  14. Hohnloser SH, Hijazi Z, Thomas L, et al. Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J. 2012; 33(22): 2821–2830.
  15. Hu PT, Lopes RD, Stevens SR, et al. ARISTOTLE Investigators, ARISTOTLE and RE-LY Investigators, Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Steering Committee and Investigators, ARISTOTLE Committees and Investigators, ARISTOTLE Committees and Investigators, ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365(11): 981–992.
  16. Hijazi Z, Hohnloser SH, Oldgren J, et al. Efficacy and safety of dabigatran compared with warfarin in relation to baseline renal function in patients with atrial fibrillation: a RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial analysis. Circulation. 2014; 129(9): 961–970.
  17. Lauw MN, Eikelboom JW, Coppens M, et al. ARISTOTLE and RE-LY Investigators, RE-ALIGN Investigators, RE-LY Investigators, RE-LY study group, RE-LY investigators, RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361(12): 1139–1151.
  18. Piccini JP, Hellkamp AS, Washam JB, et al. ROCKET AF Steering Committee and Investigators, Executive Steering Committee and the ROCKET AF Study Investigators, ROCKET AF Investigators, ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883–891.
  19. Fordyce CB, Hellkamp AS, Lokhnygina Y, et al. ROCKET AF Steering Committee and Investigators. On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin: Insights From ROCKET AF. Circulation. 2016; 134(1): 37–47.
  20. Link MS, Giugliano RP, Ruff CT, et al. ENGAGE AF-TIMI 48 Investigators, ENGAGE AF-TIMI 48 Investigators, ENGAGE AF-TIMI 48 Investigators, ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369(22): 2093–2104.
  21. Bohula EA, Giugliano RP, Ruff CT, et al. Impact of Renal Function on Outcomes With Edoxaban in the ENGAGE AF-TIMI 48 Trial. Circulation. 2016; 134(1): 24–36.
  22. Pelliccia F, Rosanio S, Marazzi G, et al. Efficacy and safety of novel anticoagulants versus vitamin K antagonists in patients with mild and moderate to severe renal insufficiency: Focus on apixaban. Int J Cardiol. 2016; 225: 77–81.
  23. Hijazi Z, Hohnloser SH, Andersson U, et al. Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial. JAMA Cardiol. 2016; 1(4): 451–460.
  24. Lauw MN, Eikelboom JW, Coppens M, et al. ARISTOTLE and RE-LY Investigators, RE-LY Investigators, RE-LY study group, RE-LY investigators, RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361(12): 1139–1151.
  25. Böhm M. Favourable effects of dabigatran etexilate versus warfarin on renal function change over time in patients with atrial fibrillation: results from the RE-LY trial. Clinical trial update hotline session. ESC Congress 2014.
  26. Heidbuchel H, Verhamme P, Alings M, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2013; 15(5): 625–651.
  27. Summary of product characteristic – dabigatran. Available on: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_Product_Information/human/000829/WC500041059.pdf .
  28. FDA full prescribing information for dabigatran. Available on: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/022512s017lbl.pdf, Data access: April 2013 .
  29. Huisman MV, Lip GYH, Diener HC, et al. Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: resolving uncertainties in routine practice. Thromb Haemost. 2012; 107(5): 838–847.
  30. Fordyce CB, Hellkamp AS, Lokhnygina Y, et al. ROCKET AF Steering Committee and Investigators. On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin: Insights From ROCKET AF. Circulation. 2016; 134(1): 37–47.
  31. Limdi NA, Limdi MA, Cavallari L, et al. Warfarin dosing in patients with impaired kidney function. Am J Kidney Dis. 2010; 56(5): 823–831.
  32. Fox KAA, Piccini JP, Wojdyla D, et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J. 2011; 32(19): 2387–2394.
  33. Diener HC, Aisenberg J, Ansell J, et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2. Eur Heart J. 2016 [Epub ahead of print].
  34. Patel M, Mahaffey K, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883–891.
  35. FDA full prescribing information for edoxaban. Available on: http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/206316lbl.
  36. Andò G, Capranzano P. Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with chronic kidney disease: A systematic review and network meta-analysis. Int J Cardiol. 2017; 231: 162–169.
  37. Bohula EA, Giugliano RP, Ruff CT, et al. Impact of Renal Function on Outcomes With Edoxaban in the ENGAGE AF-TIMI 48 Trial. Circulation. 2016; 134(1): 24–36.
  38. Charakterystyka produktu leczniczego Xarelto. Available on: http://leki.urpl.gov.pl/files/Xarelto.pdf .
  39. Charakterystyka produktu leczniczego Pradaxa. Available on: http://leki.urpl.gov.pl/files/Pradaxa_kapstwarde_110mg.pdf .
  40. Charakterystyka produktu leczniczego Eliquis. Available on: http://leki.urpl.gov.pl/files/16_Eliquis.pdf .
  41. Charakterystyka produktu leczniczego Lixiana. Available on: http://www.ema.europa.eu/docs/pl_PL/document_library/EPAR__Product_Information/human/002629/WC500189045.pdf .
  42. Dahal K, Kunwar S, Rijal J, et al. Stroke, Major Bleeding, and Mortality Outcomes in Warfarin Users With Atrial Fibrillation and Chronic Kidney Disease: A Meta-Analysis of Observational Studies. Chest. 2016; 149(4): 951–959.
  43. Jaroszyński A. Leczenie przeciwzakrzepowe chorych z migotaniem przedsionków i przewlekłą chorobą nerek w stadiach 3.–5. Choroby Serca i Naczyń. 2013; 10: 327–331.
  44. Karwowski W, Naumnik B. Kalcyfikacja naczyń — problem interdyscyplinarny. Forum Nefrol. 2011; 4(2): 91–99.
  45. Di Maso V, Carraro M, Bevilacqua E, et al. Warfarin-related nephropathy: possible role for the warfarin pharmacogenetic profile. Clin Kidney J. 2014; 7(6): 605–608.
  46. Pelliccia F, Rosanio S, Marazzi G, et al. Efficacy and safety of novel anticoagulants versus vitamin K antagonists in patients with mild and moderate to severe renal insufficiency: Focus on apixaban. Int J Cardiol. 2016; 225: 77–81.
  47. MedWatch The FDA safety information and adverse event reporting program: Eliquis (apixaban) tablets. Available on: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm384790.htm., Access data September 2015 .
  48. Diener HC, Aisenberg J, Ansell J, et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2. Eur Heart J. 2016 [Epub ahead of print].
  49. Chang M, Yu Z, Shenker A, et al. Effect of renal impairment on the pharmacokinetics, pharmacodynamics, and safety of apixaban. J Clin Pharmacol. 2016; 56(5): 637–645.
  50. Pathak R, Pandit A, Karmacharya P, et al. Meta-analysis on risk of bleeding with apixaban in patients with renal impairment. Am J Cardiol. 2015; 115(3): 323–327.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl