Application of new oral anticoagulants in patients with renal insufficiency
The use of dabigatran etexilate, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation to prevent thromboembolic incidents was proven in patients in large clinical studies. Their use, in patients with moderate renal insufficiency, is always a concern of resident doctors, so the information stemming from a sub-analysis of clinical studies is very important. However, the information is encouraging: Dabigatran etexilate maintained superiority in terms of its therapeutic effect for the full dose of 2x150 mg daily, 2x110 mg dosing was equal to rivaroxaban 1x20 mg dose, and apixaban 2x5 mg, with a comparable effect of warfarin. It is particularly important that the medicines are used safely and in extremely high doses and that they do not cause increased risk of bleeding in patients, due to kidney damage. According to the Guidelines for the treatment of atrial fibrillation of the European Society of Cardiology, application of new oral anticoagulants in patients with creatinine clearance above 30 mL/min is safe and effective.
Key words:
apixaban; atrial fibrillation; bleeding; dabigatran etexilate; renal failure; rivaroxaban, warfarin; thromboembolic accidents