Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 68, Issue 13, Pages 1452-1464Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2016.06.057
Keywords
anticoagulation; bleeding risk; stroke prevention
Categories
Funding
- Daiichi-Sankyo
- Pfizer
- Bayer
- Boehringer-Ingelheim
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A bidirectional relationship exists between atrial fibrillation (AF) and chronic renal disease. Patients with AF have a higher incidence of renal dysfunction, and the latter predisposes to incident AF. The coexistence of both conditions results in a higher risk for thromboembolic-related adverse events but a paradoxical increased hemorrhagic risk. Oral anticoagulants (both vitamin K antagonists [VKAs] and non-VKA oral anticoagulants [NOACs]) have been demonstrated to be effective in mild to moderate renal dysfunction. Patients with severe renal impairment were excluded from the non-VKA oral anticoagulant trials, so limited data are available. In end-stage renal failure, the net clinical benefit of VKAs in dialysis-dependent patients remains uncertain, although some evidence suggests that such patients may do well with high-quality anticoagulation control. Risk stratification and careful follow-up of such patients are necessary to ensure a net clinical benefit from thromboprophylaxis. (C) 2016 by the American College of Cardiology Foundation.
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