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Review
. 2020 Dec 28;10(1):83.
doi: 10.3390/jcm10010083.

Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

Michele Magnocavallo  1 , Antonio Bellasi  2 , Marco Valerio Mariani  1 , Maria Fusaro  3 , Maura Ravera  4 , Ernesto Paoletti  4 , Biagio Di Iorio  5 , Vincenzo Barbera  6 , Domenico Giovanni Della Rocca  7 , Roberto Palumbo  8 , Paolo Severino  1 , Carlo Lavalle  1 , Luca Di Lullo  6
Affiliations
Review

Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

Michele Magnocavallo et al. J Clin Med. .

Abstract

Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.

Keywords: atrial fibrillation; chronic kidney disease; direct oral anticoagulants; end stage renal disease; left atrial appendage occlusion; warfarin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prevalence of atrial fibrillation (AF) in chronic kidney disease (CKD) patients and vice versa.
Figure 2
Figure 2
Factors increasing the propensity of thrombus formation in CKD patients.
Figure 3
Figure 3
Factors contributing to pro-hemorrhagic state in CKD patients.
Figure 4
Figure 4
Comparison between direct oral anticoagulants (DOACs) and warfarin in terms of renal preservation.
Figure 5
Figure 5
Vascular calcification, arterial and renal damage induced by inhibition of vitamin-K-dependent MGP.
Figure 6
Figure 6
Pathophysiology of diabetic kidney disease. DAG: diacylglycerol; PKC: protein kinase C; ROS: reactive oxygen species.
Figure 7
Figure 7
Comparison between DOACs and Warfarin in terms of renal preservation in diabetic patients.
Figure 8
Figure 8
DOACs vs. warfarin in non-valvular AF patients with advanced kidney disease or undergoing dialysis.
See this image and copyright information in PMC

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