Anticoagulation therapy in patients with atrial fibrillation and chronic kidney disease

Abstract:

Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related chronic diseases with similar risk factors, comorbidities, and mutual two-way effect since AF facilitates the development and progression of CKD, while the prevalence and incidence of AF increase with a decreasing renal function. Thromboembolic events, stroke and death are more common in this population than in the patients with AF without CKD, so it is important to enable adequate protection for the patients at increased risk. Therapeutical choices are warfarin and the novel direct oral anticoagulants (DOACs). Warfarin shows  the properties of stimulating the calcification of large blood vessels as well as worsening of CKD, and warfarin hypersaturation may lead to acute kidney injury. Rivaroxaban in patients with CKD shows better preservation of kidney function than warfarin and better outcomes in terms of lower incidence of stroke and thromboembolic events.

Key words:
atrial fibrillation; chronic kidney disease; rivaroxaban; warfarin