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Internal and Emergency Medicine

, Volume 13, Issue 7, pp 1001–1004 | Cite as

Estimating renal function in patients with atrial fibrillation: which dose of direct oral anticoagulants?

  • Nicoletta Riva
  • Walter Ageno
  • Alex Gatt
IM - COMMENTARY

Atrial fibrillation (AF) is the most common cardiac dysrhythmia, affecting more than eight million people in the European Union [1]. AF is associated with a fivefold increased risk of ischemic stroke and is also an independent risk factor for stroke severity and mortality [1]. Renal impairment is common among AF patients, with a reported prevalence of mild renal impairment in 47% of patients and moderate–severe renal impairment in 18% of patients in a European registry [2]. AF patients with renal impairment are at increased risk of bleeding, stroke or systemic embolism, myocardial infarction and all-cause mortality, as compared to AF patients with normal renal function [3].

The 2016 European Society of Cardiology guidelines suggest the direct oral anticoagulants (DOACs) as the first choice anticoagulant treatment for AF patients [4]. However, all the currently available DOACs are at least partially renally excreted [5], therefore requiring an estimate of renal function before the...

Notes

Compliance with ethical standards

Conflict of interest

The Authors declare that they  have no conflict of interest.

Statement of human and animal rights

Not applicable.

Informed consent

Not applicable.

References

  1. 1.
    Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O’Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2018) Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation 137(12):e67–e492CrossRefPubMedGoogle Scholar
  2. 2.
    Boriani G, Laroche C, Diemberger I, Popescu MI, Rasmussen LH, Petrescu L, Crijns HJ, Tavazzi L, Maggioni AP, Lip GY (2016) Glomerular filtration rate in patients with atrial fibrillation and 1-year outcomes. Sci Rep 6:30271CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Olesen JB, Lip GY, Kamper AL, Hommel K, Køber L, Lane DA, Lindhardsen J, Gislason GH, Torp-Pedersen C (2012) Stroke and bleeding in atrial fibrillation with chronic kidney disease. N Engl J Med 367(7):625–635CrossRefPubMedGoogle Scholar
  4. 4.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, ESC Scientific Document Group (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37(38):2893–2962CrossRefGoogle Scholar
  5. 5.
    Riva N, Ageno W (2015) Pros and cons of vitamin K antagonists and non-vitamin K antagonist oral anticoagulants. Semin Thromb Hemost 41(2):178–187CrossRefPubMedGoogle Scholar
  6. 6.
    Malavasi VL, Pettorelli D, Fantecchi E, Zoccali C, Laronga G, Trenti T, Lip GYH, Boriani G (2018) Variations in clinical management of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation according to different equations for estimating renal function—post-hoc analysis of a prospective cohort. Intern Emerg Med.  https://doi.org/10.1007/s11739-018-1857-3 CrossRefGoogle Scholar
  7. 7.
    Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3(1):1–150CrossRefGoogle Scholar
  8. 8.
    Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM, Investigators ROCKETAF (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365(10):883–891CrossRefPubMedGoogle Scholar
  9. 9.
    Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Špinar J, Ruzyllo W, Ruda M, Koretsune Y, Betcher J, Shi M, Grip LT, Patel SP, Patel I, Hanyok JJ, Mercuri M, Antman EM, ENGAGE AF-TIMI 48 Investigators (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369(22):2093–2104CrossRefPubMedGoogle Scholar
  10. 10.
    Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, RE-LY Steering Committee and Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151CrossRefPubMedGoogle Scholar
  11. 11.
    Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L, ARISTOTLE Committees and Investigators (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365(11):981–992CrossRefPubMedGoogle Scholar
  12. 12.
    Sciascia S, Radin M, Schreiber K, Fenoglio R, Baldovino S, Roccatello D (2017) Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents. Intern Emerg Med 12(8):1101–1108CrossRefPubMedGoogle Scholar
  13. 13.
    Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Collins R, Camm AJ, Heidbüchel H, ESC Scientific Document Group (2018) The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 39(16):1330–1393CrossRefPubMedGoogle Scholar
  14. 14.
    Dowling TC, Wang ES, Ferrucci L, Sorkin JD (2013) Glomerular filtration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore Longitudinal Study on Aging: impact on renal drug dosing. Pharmacotherapy 33(9):912–921CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cirillo M, Anastasio P, De Santo NG (2005) Relationship of gender, age, and body mass index to errors in predicted kidney function. Nephrol Dial Transplant 20(9):1791–1798CrossRefPubMedGoogle Scholar
  16. 16.
    Becattini C, Giustozzi M, Ranalli MG, Bogliari G, Cianella F, Verso M, Agnelli G, Vedovati MC (2018) Variation of renal function over time is associated with major bleeding in patients treated with direct oral anticoagulants for atrial fibrillation. J Thromb Haemost 16(5):833–841CrossRefPubMedGoogle Scholar
  17. 17.
    Prisco D, Ageno W, Becattini C, D’Angelo A, Davì G, De Cristofaro R, Dentali F, Di Minno G, Falanga A, Gussoni G, Masotti L, Palareti G, Pignatelli P, Santi RM, Santilli F, Silingardi M, Tufano A, Violi F, SIMI (Italian Society of Internal Medicine), FADOI (Federation of Associations of Hospital Doctors on Internal Medicine), SISET (Italian Society for the Study of Haemostasis and Thrombosis) (2017) Italian intersociety consensus on DOAC use in internal medicine. Intern Emerg Med 12(3):387–406CrossRefPubMedGoogle Scholar
  18. 18.
    Minhas AS, Jiang Q, Gu X, Haymart B, Kline-Rogers E, Almany S, Kozlowski J, Krol GD, Kaatz S, Froehlich JB, Barnes GD (2016) Renal function in atrial fibrillation patients switched from warfarin to a direct oral anticoagulant. J Thromb Thrombolysis 42(4):566–572CrossRefPubMedGoogle Scholar
  19. 19.
    Del-Carpio Munoz F, Gharacholou SM, Munger TM, Friedman PA, Asirvatham SJ, Packer DL, Noseworthy PA (2016) Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation. Am J Cardiol 117(1):69–75CrossRefPubMedGoogle Scholar
  20. 20.
    European Medicines Agency. Eliquis (apixaban): summary of product characteristics. http://www.emaeuropaeu/docs/en_GB/document_library/EPAR_Product_Information/human/002148/WC500107728pdf. Accessed 8 Apr 2018
  21. 21.
    European Medicines Agency. Pradaxa (dabigatran etexilate): summary of product characteristics. http://www.emaeuropaeu/docs/en_GB/document_library/EPAR_Product_Information/human/000829/WC500041059pdf. Accessed 8 Apr 2018
  22. 22.
    European Medicines Agency. Lixiana (edoxaban): summary of product characteristics. http://www.emaeuropaeu/docs/en_GB/document_library/EPAR_Product_Information/human/002629/WC500189045pdf. Accessed 8 Apr 2018
  23. 23.
    European Medicines Agency. Xarelto (rivaroxaban): summary of product characteristics. http://www.emaeuropaeu/docs/en_GB/document_library/EPAR_Product_Information/human/000944/WC500057108pdf. Accessed 8 Apr 2018

Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Department of Pathology, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
  2. 2.Department of Medicine and SurgeryUniversity of InsubriaVareseItaly

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