Kumar, S, Lim, E, Covic, A et al. (4 more authors) (2019) Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation: JACC Review Topic of the Week. Journal of the American College of Cardiology, 74 (17). pp. 2204-2215. ISSN 0735-1097
Abstract
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Keywords: | atrial fibrillation; chronic kidney disease; direct oral anticoagulant; haemorrhage; stroke; vitamin K antagonist; warfarin |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 25 Oct 2019 10:01 |
Last Modified: | 25 Oct 2019 10:01 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jacc.2019.08.1031 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:152582 |