title: Atrial Fibrillation and Thromboembolism in Patients With Chronic Kidney Disease.
abstract: 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.
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom.
authors.forename: Yee C
authors.initials: YC
authors.lastname: Lau
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Proietti
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom; Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Guiducci
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Blann
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
mesh_terms: D000284:Administration, Oral; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications*; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: anticoagulation; bleeding risk; stroke prevention