The Choice of Anticoagulant Therapy in Patients With Non-Valvular Atrial Fibrillation and Chronic Kidney Disease

The review shows the prevalence of atrial fibrillation (AF) in patients with chronic kidney disease (CKD), depending on the severity of the disease. Patients with non-valvular AF and CKD have a significantly increased risk of both bleeding and thromboembolic complications, and death from all causes. Evaluation of the results of randomized clinical trials (RCTs), meta-analyzes of RCTs demonstrated the advantages of the new oral anticoagulants (NOAC), such as dabigatran, rivaroxaban, apixaban, compared with warfarin in reducing the risk of bleeding in patients with AF and CKD in predialysis stage. According to experimental and clinical studies, warfarin can promote renal vascular calcification. With the deterioration of filtration renal function during treatment with anticoagulants in patients with AF on the results of ROCKET AF study found that rivaroxaban is more preferable than warfarin in reducing the risk of stroke and systemic embolism without increasing the risk of bleeding. The absence of RCT data complicates the choice of anticoagulant therapy in patients with CKD on hemodialysis, although the NOAC approved by the Office of Quality Control Food and Drug US drugs (FDA) for the use of patients in this category. According to the instruction drugs rivaroxaban and apixaban are allowed to use in patients with end-stage CKD with creatinine clearance not less than 15 ml/min.