Kumar, S; Lim, E; Covic, A; Verhamme, P; Gale, CP; Camm, AJ; Goldsmith, D
(2019)
Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation JACC Review Topic of the Week.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 74 (17).
pp. 2204-2215.
ISSN 0735-1097
https://doi.org/10.1016/j.jacc.2019.08.1031
SGUL Authors: Camm, Alan John
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Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist as they share multiple risk factors, including hypertension, diabetes mellitus, and coronary artery disease. Although there is irrefutable evidence supporting anticoagulation in AF in the general population, these data may not be transferable to the setting of advanced CKD, where the decision to commence anticoagulation poses a conundrum. In this cohort, there is a progressively increased risk of both ischemic stroke and hemorrhage as renal function declines, complicating the decision to initiate anticoagulation. No definitive clinical guidelines derived from randomized controlled trials exist to aid clinical decision-making, and the findings from observational studies are conflicting. In this review, the authors outline the pathophysiological mechanisms at play and summarize the limited existing data related to anticoagulation in those with concomitant CKD and AF. Finally, the authors suggest how to approach the decision of whether and how to use oral anticoagulation in these patients.
Item Type: | Article | ||||||||
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Additional Information: | © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ | ||||||||
Keywords: | atrial fibrillation, chronic kidney disease, direct oral anticoagulant, hemorrhage, stroke, vitamin K antagonist, warfarin, 1102 Cardiovascular Medicine And Haematology, 1117 Public Health And Health Services, Cardiovascular System & Hematology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | ||||||||
ISSN: | 0735-1097 | ||||||||
Dates: |
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Web of Science ID: | WOS:000491235900012 | ||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/111338 | ||||||||
Publisher's version: | https://doi.org/10.1016/j.jacc.2019.08.1031 |
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