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Acta clinica Croatica, Vol. 60. No. Supplement 1, 2021.

Original scientific paper

https://doi.org/10.20471/acc.2021.60.s1.15

Anticoagulant Treatment in Patients with Atrial Fibrillation and Chronic Kidney Disease

Marta Popović orcid id orcid.org/0000-0002-5844-2130 ; General hospital Varaždin, Varaždin, Croatia
Karmela Altabas ; University Hospital Center Sestre milosrdnice, Zagreb, Croatia; School of dental medicine, University of Zagreb, Zagreb, Croatia
Matias Trbušić orcid id orcid.org/0000-0001-9428-454X ; University Hospital Center Sestre milosrdnice, Zagreb, Croatia; School of medicine, Universitiy of Zagreb, Zagreb, Croatia

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Abstract

Aim: To investigate the efficacy and safety profile of oral anticoagulants and determine
the best treatment for patients with atrial fibrillation (AF) and chronic kidney disease (CKD ).
Methods and materials: A systematic assessment of literature from Pubmed/MEDLINE was performed
in search of studies evaluating the efficacy, safety, pharmacokinetics, and pharmacodynamics
of direct oral anticoagulants (DOACs) and warfarin in patients with CKD .
Results: According to guidelines, DOACs are the treatment of choice for patients with CKD 1–3
(Crcl ≥ 30 mL/min) due to their high efficacy, better safety profile, and fewer food/drug and drug/
drug interactions than warfarin. For patients with CKD 4 (Crcl 15-29 mL/min), there are no such
strong recommendations as to which group of anticoagulants is the better choice, and for those with
CKD 5 (Crcl <15 mL/min), the choice is currently narrowed to warfarin or apixaban. However, there
seem to be more negative effects of warfarin, including accelerated CKD progression and increased
risk of bleeding compared to DOACs.
Conclusion: Considering their superior safety profile and the possibility of apixaban, rivaroxaban,
and edoxaban to achieve an adequate anticoagulant effect even in severe kidney disease, DOACs seem
to be a better option for anticoagulant treatment of patients with AF and CKD .

Keywords

Atrial fibrillation; Anticoagulant treatment; Chronic kidney disease

Hrčak ID:

260410

URI

https://hrcak.srce.hr/260410

Publication date:

1.1.2021.

Article data in other languages: croatian

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