期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 74, 期 17, 页码 2204-2215出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2019.08.1031
关键词
atrial fibrillation; chronic kidney disease; direct oral anticoagulant; hemorrhage; stroke; vitamin K antagonist; warfarin
资金
- National Health for National Institute for Health Research (NIHR) Academic Clinical Fellow scheme
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Bayer Healthcare
- Daiichi-Sankyo
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist as they share multiple risk factors, including hypertension, diabetes mellitus, and coronary artery disease. Although there is irrefutable evidence supporting anticoagulation in AF in the general population, these data may not be transferable to the setting of advanced CKD, where the decision to commence anticoagulation poses a conundrum. In this cohort, there is a progressively increased risk of both ischemic stroke and hemorrhage as renal function declines, complicating the decision to initiate anticoagulation. No definitive clinical guidelines derived from randomized controlled trials exist to aid clinical decision-making, and the findings from observational studies are conflicting. In this review, the authors outline the pathophysiological mechanisms at play and summarize the limited existing data related to anticoagulation in those with concomitant CKD and AF. Finally, the authors suggest how to approach the decision of whether and how to use oral anticoagulation in these patients. (C) 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.
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