Renal Function Considerations for Stroke Prevention in Atrial Fibrillation

The American Journal of Medicine
John FanikosPaul P Dobesh

Abstract

Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants (DOACs) have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, DOACs were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in nonvalvular atrial fibrillation patients with mild or moderate renal impairment. Renal function decrease appears less impacted by DOACs, which are associated with a better risk-benefit profile than warfarin in patients with decreasing renal function over time. Limited data address the risk-benefit profile of DOACs in patients with severe impairment or on dialysis.

References

Jan 1, 1976·Nephron·D W Cockcroft, M H Gault
Aug 16, 2006·Annals of Internal Medicine·Andrew S LeveyUNKNOWN Chronic Kidney Disease Epidemiology Collaboration
May 6, 2009·Annals of Internal Medicine·Andrew S LeveyUNKNOWN CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Mar 20, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Wieneke Marleen MichelsRaymond Theodorus Krediet
Oct 5, 2010·BMJ : British Medical Journal·Meng LeeBruce Ovbiagele
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Sep 10, 2011·Clinical Journal of the American Society of Nephrology : CJASN·Robert G HartCharles A Herzog
Aug 17, 2012·The New England Journal of Medicine·Jonas Bjerring OlesenChristian Torp-Pedersen
Nov 21, 2013·The New England Journal of Medicine·Robert P GiuglianoUNKNOWN ENGAGE AF-TIMI 48 Investigators
Jan 18, 2015·Circulation·Kevin E ChanFranklin W Maddux
Feb 15, 2015·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Philip MassonJonathan C Craig
May 1, 2015·Circulation Journal : Official Journal of the Japanese Circulation Society·Yukihiro KoretsuneMasahiro Yasaka
Jun 13, 2015·Journal of the American College of Cardiology·Michael BöhmLars Wallentin
Jun 22, 2015·American Heart Journal·Sean D PokorneyUNKNOWN Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators
Sep 12, 2015·Journal of Clinical Pharmacology·Ming ChangCharles E Frost
Dec 25, 2015·The American Journal of Cardiology·Freddy Del-Carpio MunozPeter A Noseworthy
Apr 22, 2016·American Journal of Nephrology·Clapton DiasMatthew R Weir
Oct 25, 2016·The American Journal of Medicine·Megan E BarraSamuel Z Goldhaber
Jul 1, 2016·Circulation·Erin A BohulaEugene Braunwald
Jul 1, 2016·Circulation·Christopher B FordyceUNKNOWN ROCKET AF Steering Committee and Investigators
Jul 2, 2016·Journal of the American College of Cardiology·Freddy Del-Carpio MunozPeter A Noseworthy
Jul 28, 2016·JAMA Cardiology·John H AlexanderUNKNOWN Apixaban for Reduction of Stroke and Other Thromboembolic Complications in Atrial Fibrillation (ARISTOTLE) Investigators
Jul 29, 2016·Scientific Reports·Giuseppe BorianiGregory Y H Lip
Dec 17, 2016·Journal of the American College of Cardiology·Benjamin A SteinbergUNKNOWN ORBIT-AF Investigators and Patients
Mar 18, 2017·Journal of the American Society of Nephrology : JASN·Thomas A MavrakanasMark L Lipman

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Citations

May 31, 2018·Journal of Thrombosis and Thrombolysis·Michael BowieMinh-Ha Tran
Mar 7, 2018·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jordanne FeldbergMarisa Battistella
May 18, 2018·Clinical Journal of the American Society of Nephrology : CJASN·Frieder Keller, Alexander Hann
May 22, 2019·Journal of Thrombosis and Thrombolysis·Martin M GrucaGeoffrey D Barnes
Jan 9, 2020·Heart·Taku InoharaUNKNOWN ORBIT AF Patients and Investigators
May 16, 2019·Stroke; a Journal of Cerebral Circulation·So-Ryoung LeeGregory Y H Lip
Jan 29, 2019·Journal of Nephrology·Kelvin Cheuk-Wai Leung, Jennifer Marie MacRae
Sep 1, 2018·European Journal of Drug Metabolism and Pharmacokinetics·Roberto Padrini
May 31, 2018·SAGE Open Medical Case Reports·Nobuhiro Akuzawa, Masahiko Kurabayashi
May 19, 2019·Clinical Cardiology·Viviana Aursulesei, Irina Iuliana Costache
Jul 21, 2020·Expert Review of Clinical Pharmacology·Morteza NabieeBehrouz Khajeh
Jun 16, 2021·Journal of Clinical Pharmacy and Therapeutics·Kaye DizonMarisa Battistella

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