Oral Anticoagulant Treatment of Atrial Fibrillation in Chronic Kidney Disease Patients

Abstract

Nonvalvular atrial fibrillation is the most prevalent sustained arrhythmia in chronic kidney disease patients. When compared to warfarin, new oral anticoagulants are found to be non-inferior or superior in safety and efficacy outcomes in the general population. The efficacy and safety of anticoagulation in mild chronic kidney disease is similar to the general population. Studies are yielding conflicting results in moderate to advanced chronic kidney disease and end stage renal disease. Due to hemostasis dysfunction in chronic kidney disease, both bleeding and thromboembolism risk increase. Advanced chronic kidney disease and end stage renal disease patients are excluded from randomized controlled trials. Our knowledge about the efficacy, safety and dose adjustments of warfarin and new oral anticoagulants are based on observational data. According to the recent studies, apixaban and edoxaban use in moderate chronic kidney disease with a glomerular filtration rate between 30-50 mL/min may be safer than warfarin. There are no high quality evidence to recommend the use of warfarin in advanced and end stage chronic kidney disease patients. The Food and Drug Administration approved the use of apixaban in end stage renal disease. Randomized controlled trials are needed to evaluate the use of oral anticoagulants in advanced chronic kidney disease.