Anticoagulation in chronic kidney disease patients with atrial fibrillation: old vs new drugs

Abstract

In the last two decades a group of novel oral anticoagulants (NOACs) has been developed that directly block the activity of thrombin or activated factor X. No randomized controlled trials have been conducted to verify their efficacy and safety in patients with advanced chronic kidney disease (CKD) and atrial fibrillation. Few studies compared NOACs (dabigatran, rivaroxaban, apixaban, edoxaban) with classic anticoagulants in this unique group, and the results of these analyses remain controversial and inconclusive. Simple extrapolation of recommendations from the general population may be erroneous and lead to an increased risk of complications. Several controlled randomized trials with oral direct anticoagulants in hemodialysis patients are currently underway.

Keywords: Chronic kidney disease (CKD); dabigatran; anticoagulation; atrial fibrillation; rivaroxaban; warfarin; novel oral anticoagulants (NOACs).