Genovesi, S;
Camm, AJ;
Covic, A;
Burlacu, A;
Meijers, B;
Franssen, C;
Luyckx, V;
Liakopoulos, V;
Alfano, G;
Combe, C;
et al.
Genovesi, S; Camm, AJ; Covic, A; Burlacu, A; Meijers, B; Franssen, C; Luyckx, V; Liakopoulos, V; Alfano, G; Combe, C; Basile, C
(2024)
Treatment strategies of the thromboembolic risk in kidney failure patients with atrial fibrillation.
Nephrol Dial Transplant, 39 (8).
pp. 1248-1257.
ISSN 1460-2385
https://doi.org/10.1093/ndt/gfae121
SGUL Authors: Camm, Alan John
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Abstract
The incidence and prevalence of atrial fibrillation (AF) in patients affected by kidney failure, i.e. glomerular filtration rate <15 ml/min/1.73 m2, is high and probably underestimated. Numerous uncertainties remain regarding how to prevent thromboembolic events in this population because both cardiology and nephrology guidelines do not provide clear recommendations. The efficacy and safety of oral anticoagulant therapy (OAC) in preventing thromboembolism in patients with kidney failure and AF has not been demonstrated for either vitamin K antagonists (VKAs) or direct anticoagulants (DOACs). Moreover, it remains unclear which is more effective and safer, because estimated creatinine clearance <25-30 ml/min was an exclusion criterion in the randomized controlled trials (RCTs). Three RCTs comparing DOACs and VKAs in kidney failure failed to reach the primary endpoint, as they were underpowered. The left atrial appendage is the main source of thromboembolism in the presence of AF. Left atrial appendage closure (LAAC) has recently been proposed as an alternative to OAC. RCTs comparing the efficacy and safety of LAAC versus OAC in kidney failure were terminated prematurely due to recruitment failure. A recent prospective study showed a reduction in thromboembolic events in haemodialysis patients with AF and undergoing LAAC compared with patients taking or not taking OAC. We review current treatment standards and discuss recent developments in managing the thromboembolic risk in kidney failure patients with AF. The importance of shared decision-making with the multidisciplinary team and the patient to consider individual risks and benefits of each treatment option is underlined.
Item Type: | Article | ||||||
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Additional Information: | © The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | ||||||
Keywords: | atrial fibrillation, kidney failure, left atrial appendage closure, oral anticoagulant therapy, thromboembolism, Humans, Atrial Fibrillation, Thromboembolism, Anticoagulants, Renal Insufficiency, Risk Factors, atrial fibrillation, kidney failure, left atrial appendage closure, oral anticoagulant therapy, thromboembolism, 1103 Clinical Sciences, Urology & Nephrology | ||||||
SGUL Research Institute / Research Centre: | Academic Structure > REF 2021 user group | ||||||
Journal or Publication Title: | Nephrol Dial Transplant | ||||||
ISSN: | 1460-2385 | ||||||
Language: | eng | ||||||
Dates: |
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Publisher License: | Creative Commons: Attribution-Noncommercial 4.0 | ||||||
PubMed ID: | 38816212 | ||||||
Web of Science ID: | WOS:001248545700001 | ||||||
Go to PubMed abstract | |||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/116574 | ||||||
Publisher's version: | https://doi.org/10.1093/ndt/gfae121 |
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