Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are disorders with increasing prevalence. The presence of CKD increases the risk of incident AF and vice versa, and the presence of AF may accelerate CKD progression. Nearly a third of patients with established CKD also have AF, whilst half of AF patients may have some degree of renal dysfunction. Both AF and CKD are associated with increased cardiovascular morbidity and mortality, including significantly increased risk of stroke or systemic embolism. Oral anticoagulant therapy (OAC), either with vitamin K antagonists or with non-vitamin K oral anticoagulants (NOACs) is essential to optimise prevention of stroke and systemic embolism in AF patients with one or more stroke risk factors, and NOACs are more convenient and generally safer than vitamin K antagonists mostly due to consistently reduced risk of intracranial bleeding.
The use of OAC must be balanced against the risk of OAC-related bleeding, which depends on the presence of bleeding risk factors. Renal failure is a well-established bleeding risk factor and renal function should be routinely assessed in all patients presenting with AF. Since the risk of bleeding increases in parallel with CKD severity, the clinical decision to use OAC in AF patients with severe CKD may be challenging. In this review article we summarize the OAC agents currently used in clinical practice and discuss the role of NOACs for stroke prevention in patients with AF and CKD.
Keywords: Atrial fibrillation, chronic kidney disease, renal failure, stroke prevention, oral anticoagulation, vitamin K antagonists, warfarin, non-vitamin K antagonist oral anticoagulants.
Current Medicinal Chemistry
Title:Non-Vitamin K Oral Anticoagulant Drugs for Stroke Prevention in Patients with Atrial Fibrillation and Chronic Kidney Disease
Volume: 23 Issue: 19
Author(s): Tatjana S. Potpara, Vera Jokic, Nikolaos Dagres, Torben B. Larsen, Deirdre A. Lane, Gerhard Hindricks and Gregory Y.H. Lip
Affiliation:
Keywords: Atrial fibrillation, chronic kidney disease, renal failure, stroke prevention, oral anticoagulation, vitamin K antagonists, warfarin, non-vitamin K antagonist oral anticoagulants.
Abstract: Atrial fibrillation (AF) and chronic kidney disease (CKD) are disorders with increasing prevalence. The presence of CKD increases the risk of incident AF and vice versa, and the presence of AF may accelerate CKD progression. Nearly a third of patients with established CKD also have AF, whilst half of AF patients may have some degree of renal dysfunction. Both AF and CKD are associated with increased cardiovascular morbidity and mortality, including significantly increased risk of stroke or systemic embolism. Oral anticoagulant therapy (OAC), either with vitamin K antagonists or with non-vitamin K oral anticoagulants (NOACs) is essential to optimise prevention of stroke and systemic embolism in AF patients with one or more stroke risk factors, and NOACs are more convenient and generally safer than vitamin K antagonists mostly due to consistently reduced risk of intracranial bleeding.
The use of OAC must be balanced against the risk of OAC-related bleeding, which depends on the presence of bleeding risk factors. Renal failure is a well-established bleeding risk factor and renal function should be routinely assessed in all patients presenting with AF. Since the risk of bleeding increases in parallel with CKD severity, the clinical decision to use OAC in AF patients with severe CKD may be challenging. In this review article we summarize the OAC agents currently used in clinical practice and discuss the role of NOACs for stroke prevention in patients with AF and CKD.
Export Options
About this article
Cite this article as:
Potpara S. Tatjana, Jokic Vera, Dagres Nikolaos, Larsen B. Torben, Lane A. Deirdre, Hindricks Gerhard and Lip Y.H. Gregory, Non-Vitamin K Oral Anticoagulant Drugs for Stroke Prevention in Patients with Atrial Fibrillation and Chronic Kidney Disease, Current Medicinal Chemistry 2016; 23 (19) . https://dx.doi.org/10.2174/0929867323666160210130109
DOI https://dx.doi.org/10.2174/0929867323666160210130109 |
Print ISSN 0929-8673 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-533X |
Call for Papers in Thematic Issues
Advances in Medicinal Chemistry: From Cancer to Chronic Diseases.
The broad spectrum of the issue will provide a comprehensive overview of emerging trends, novel therapeutic interventions, and translational insights that impact modern medicine. The primary focus will be diseases of global concern, including cancer, chronic pain, metabolic disorders, and autoimmune conditions, providing a broad overview of the advancements in ...read more
Approaches to the treatment of chronic inflammation
Chronic inflammation is a hallmark of numerous diseases, significantly impacting global health. Although chronic inflammation is a hot topic, not much has been written about approaches to its treatment. This thematic issue aims to showcase the latest advancements in chronic inflammation treatment and foster discussion on future directions in this ...read more
Cellular and Molecular Mechanisms of Non-Infectious Inflammatory Diseases: Focus on Clinical Implications
The Special Issue covers the results of the studies on cellular and molecular mechanisms of non-infectious inflammatory diseases, in particular, autoimmune rheumatic diseases, atherosclerotic cardiovascular disease and other age-related disorders such as type II diabetes, cancer, neurodegenerative disorders, etc. Review and research articles as well as methodology papers that summarize ...read more
Chalcogen-modified nucleic acid analogues
Chalcogen-modified nucleosides, nucleotides and oligonucleotides have been of great interest to scientific research for many years. The replacement of oxygen in the nucleobase, sugar or phosphate backbone by chalcogen atoms (sulfur, selenium, tellurium) gives these biomolecules unique properties resulting from their altered physical and chemical properties. The continuing interest in ...read more
![Wayfinder Image](/images/wayfinder.jpg)
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Pulmonary Complications After Congenital Heart Surgery
Current Respiratory Medicine Reviews p38 MAP Kinase Mediated Proteoglycan Synthesis as a Target for the Prevention of Atherosclerosis
Cardiovascular & Hematological Disorders-Drug Targets Nutrigenetics of the Postprandial Lipoprotein Metabolism: Evidences From Human Intervention Studies
Current Vascular Pharmacology Stem Cells: Clinical Trials Results The End of the Beginning or the Beginning of the End?
Cardiovascular & Hematological Disorders-Drug Targets Matrix Metalloproteinases and Vulnerable Atheromatous Plaque
Current Topics in Medicinal Chemistry Prognostic Role of miRNAs in Coronary Artery Disease
Current Topics in Medicinal Chemistry Advances in Drug Safety
Current Pharmaceutical Design Role of Nitric Oxide in Ischemia and Reperfusion Injury
Current Medicinal Chemistry - Anti-Inflammatory & Anti-Allergy Agents Analysis of the Research Hotspot of Exosomes in Cardiovascular Disease: A Bibliometric-based Literature Review
Current Vascular Pharmacology The Widespread Anti-Protozoal Action of HIV Aspartic Peptidase Inhibitors: Focus on Plasmodium spp., Leishmania spp. and Trypanosoma cruzi
Current Topics in Medicinal Chemistry Effect of Physical Exercise on Cardiac Autonomic Modulation in Hypertensive Individuals: A Systematic Review and Meta-analysis
Current Hypertension Reviews MTHFR Gene Polymorphism and Diabetic Retinopathy
Current Diabetes Reviews HM74a Agonists: Will they be the New Generation of Nicotinic Acid?
Current Topics in Medicinal Chemistry Editorial [ Hot Topic:The Medicinal Chemistry of New Agents to Treat Diabetes and Obesity (Guest Editor: Jie-Fei Cheng)]
Current Topics in Medicinal Chemistry Efficient Chemical Synthesis of a Scutellarein Derivative Containing Morpholine Ring
Letters in Organic Chemistry Leptin and Inflammation
Current Immunology Reviews (Discontinued) The Roles of Cytochrome P450 in Ischemic Heart Disease
Current Drug Metabolism Neuroprotective Effects of Quercetin: From Chemistry to Medicine
CNS & Neurological Disorders - Drug Targets Stroke and Neuroinflamation: Role of Sexual Hormones
Current Pharmaceutical Design Rationalizing the Study of Plants for the Treatment of Oral Pain
Current Chemical Biology