Anticoagulation therapy in patients with chronic kidney disease

For decades, anticoagulation therapy has been a cornerstone of comprehensive management of patients with atrial fibrillation. Chronic renal disease is a common condition in a significant proportion of these patients and increases largely the risk of stroke or systemic embolism. Despite clear benefit of anticoagulation therapy in prevention of these complications, the use of this treatment in patients with seriously reduced renal function is still controversial. Although there is a large body of evidence form clinical trials supporting the treatment with novel oral anticoagulants (NOAC) over warfarin in management of patients with mild or moderate reduction of renal function. In this growing subgroup of patients with atrial fibrillation NOACs are in recommended dosage at least equal or even better than warfarin in safety and effectiveness. The use of dabigatran and rivaroxaban even slows down the declination of glomerular filtration compared to warfarin. According to the registration trials the current NOAC anticoagulation therapy guidelines are based on the use of creatinine clearance (CICr) which is not identical to estimated glomerular filtration (eGFR). The knowledge of ClCr is crucial for proper management of NOAC anticoagulation therapy.