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

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.

Risk of left atrial appendage thrombus in older patients with atrial fibrillation

“…The aetiology, course of illness, and thromboembolic outcomes in older patients with AF might differ from those in the younger population with AF [ 4 ]. The pathogenesis of AF in the young with structurally normal atria but electrophysiological “triggers” in the form of pulmonary vein ectopic foci is in stark contrast to that observed in older patients, who develop AF primarily due to structural abnormalities including atrial fibrosis and dilatation as well as systemic disorders such as chronic kidney disease (CKD) [ 5 , 6 ]. Haemodynamic consequences of loss of atrial contraction in AF are usually more pronounced in older patients with stiffer left ventricles compared to young individuals [ 1 ].…”

COVID-19-induced coagulopathy: Experience, achievements, prospects

“…Coagulation should be closely monitored during treatment to prevent excessive anticoagulant therapy and bleeding [ 65 , 66 ]. Anti-Xa levels and ARTT ratios are good ways to determine the effectiveness of LMWH in patients with confirmed deep vein thrombosis.…”