Renal Function Considerations for Stroke Prevention in Atrial Fibrillation

John Fanikos, Allison E. Burnett, Charles E. Mahan, Paul P. Dobesh

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants (DOACs) have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, DOACs were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in nonvalvular atrial fibrillation patients with mild or moderate renal impairment. Renal function decrease appears less impacted by DOACs, which are associated with a better risk-benefit profile than warfarin in patients with decreasing renal function over time. Limited data address the risk-benefit profile of DOACs in patients with severe impairment or on dialysis.

Original languageEnglish (US)
Pages (from-to)1015-1023
Number of pages9
JournalAmerican Journal of Medicine
Volume130
Issue number9
DOIs
StatePublished - Sep 2017

Fingerprint

Anticoagulants
Atrial Fibrillation
Stroke
Kidney
Warfarin
Hemorrhage
Patient Selection
Dialysis
Randomized Controlled Trials

Keywords

  • Atrial fibrillation
  • Direct oral anticoagulants

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Renal Function Considerations for Stroke Prevention in Atrial Fibrillation. / Fanikos, John; Burnett, Allison E.; Mahan, Charles E.; Dobesh, Paul P.

In: American Journal of Medicine, Vol. 130, No. 9, 09.2017, p. 1015-1023.

Research output: Contribution to journalReview article

Fanikos, John ; Burnett, Allison E. ; Mahan, Charles E. ; Dobesh, Paul P. / Renal Function Considerations for Stroke Prevention in Atrial Fibrillation. In: American Journal of Medicine. 2017 ; Vol. 130, No. 9. pp. 1015-1023.
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