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Cardio-Nephrology pp 283–294Cite as

Anticoagulation in Patients with Atrial Fibrillation and Chronic Kidney Disease

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Abstract

The incidence of co-prevalent atrial fibrillation and chronic kidney disease (CKD) is steadily increasing in an aging population. Relative to patients with normal renal function, those with CKD have a higher risk of both stroke and bleeding complications in the context of atrial fibrillation. Hence, it is particularly important to carefully weigh the risks and benefits of anticoagulation and individualize therapy for each patient in this clinical situation. The advent of the newer direct-acting oral anticoagulants (DOACs) has been a significant advance in this field and greatly increases the therapeutic armamentarium of clinicians. However, their use should be undertaken cautiously in patients with renal impairment, as doses need adjustment based on renal function. Patients with stage 3 CKD had substantial representation in the pivotal randomized trials, and helpful post hoc subgroup analysis are available to guide the clinician. However, data for patients with stage 4 CKD are limited. For patients with end-stage kidney disease on dialysis, there is conflicting observational evidence regarding the overall benefits of anticoagulation because of higher baseline risks of mortality and bleeding. This chapter addresses the epidemiological perspectives of atrial fibrillation among patients with CKD, evaluates the strength of the evidence pertaining to the use of anticoagulants (warfarin and DOACs) in this population with a close consideration of risks versus benefits; and finally provides some pragmatic reflections for the clinician to consider incorporating in the management of their patients.

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Acknowledgments

The authors would like to acknowledge and greatly appreciate the editorial assistance provided by Michelle Flemming.

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Authors and Affiliations

  1. Cardiology Division, Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN, 55415, USA

    Michelle D. Carlson & Gautam R. Shroff

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  1. Michelle D. Carlson
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  2. Gautam R. Shroff
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Correspondence to Michelle D. Carlson .

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Editors and Affiliations

  1. Department of Internal Medicine, Einstein Medical Center, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Janani Rangaswami

  2. Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois, USA

    Edgar V. Lerma

  3. Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

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Carlson, M.D., Shroff, G.R. (2017). Anticoagulation in Patients with Atrial Fibrillation and Chronic Kidney Disease. In: Rangaswami, J., Lerma, E., Ronco, C. (eds) Cardio-Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-56042-7_27

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  • DOI: https://doi.org/10.1007/978-3-319-56042-7_27

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