<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a five-fold increase in the risk for ischemic stroke. Therefore, lifelong use of anticoagulants is crucial to reduce the morbidity and mortality burden of AF. The incidence of AF in chronic kidney disease (CKD) is two to three times greater than in the general population, and there is a mutual aggravation of the two conditions as well as the presence of both an increased thromboembolic risk in CKD and an increased bleeding risk in severe CKD. The preservation of kidney function in patients with cardiovascular diseases is important, as the latter is the leading cause of death in patients with eGFR &lt;60 mL/min/1.73 m<sup>2</sup>. Similarly, kidney dysfunction is a serious limitation to the use of many cardiovascular drugs, including anticoagulants. Evidence is present for the faster progression of kidney disease with vitamin K antagonists, likely due to the vitamin K-related process of vascular calcification. Conversely, direct oral anticoagulants (DOACs) have been shown to reduce the progression of CKD and have a beneficial effect as far as the modulation of inflammation and oxidative stress are concerned in experimental models. Another less-discussed problem is the use of DOACs in advanced CKD.</p>
</abstract>

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a five-fold increase in the risk for ischemic stroke. Therefore, lifelong use of anticoagulants is crucial to reduce the morbidity and mortality burden of AF. The incidence of AF in chronic kidney disease (CKD) is two to three times greater than in the general population, and there is a mutual aggravation of the two conditions as well as the presence of both an increased thromboembolic risk in CKD and an increased bleeding risk in severe CKD. The preservation of kidney function in patients with cardiovascular diseases is important, as the latter is the leading cause of death in patients with eGFR <60 mL/min/1.73 m2. Similarly, kidney dysfunction is a serious limitation to the use of many cardiovascular drugs, including anticoagulants. Evidence is present for the faster progression of kidney disease with vitamin K antagonists, likely due to the vitamin K-related process of vascular calcification. Conversely, direct oral anticoagulants (DOACs) have been shown to reduce the progression of CKD and have a beneficial effect as far as the modulation of inflammation and oxidative stress are concerned in experimental models. Another less-discussed problem is the use of DOACs in advanced CKD.

Kidney Function and the Use of Vitamin K Antagonists or Direct Oral Anticoagulants in Atrial Fibrillation

Journal of Cardiovascular Emergencies

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a five-fold increase in the risk for ischemic stroke....

Kidney Function and the Use of Vitamin K Antagonists or Direct Oral Anticoagulants in Atrial Fibrillation

Published Online: Sep 21, 2023

Page range: 49 - 58

Received: Aug 19, 2023

Accepted: Aug 30, 2023

DOI: https://doi.org/10.2478/jce-2023-0011

Keywords
arrhythmia, anticoagulants, bleeding, renal failure, systemic thromboembolism

© 2023 Dolina Gencheva, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Kidney Function and the Use of Vitamin K Antagonists or Direct Oral Anticoagulants in Atrial Fibrillation

Published Online: Sep 21, 2023

Page range: 49 - 58

Received: Aug 19, 2023

Accepted: Aug 30, 2023

DOI: https://doi.org/10.2478/jce-2023-0011

Keywordsarrhythmia, anticoagulants, bleeding, renal failure, systemic thromboembolism

© 2023 Dolina Gencheva, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
arrhythmia, anticoagulants, bleeding, renal failure, systemic thromboembolism