Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation

Davis

et al. 2020

Cureus

Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare, life-threatening cutaneous systemic disease that typically occurs in the setting of end-stage renal disease (ESRD). ESRD is the most recognized risk factor for calciphylaxis but it is not the sole risk factor. Calciphylaxis has also been associated with liver cirrhosis with or without concurrent renal disease. The current case describes a patient who developed calciphylaxis in the setting of hemodialysis, liver cirrhosis, and atrial fibrillation managed with warfarin therapy, all risk factors for calciphylaxis. The need for alternatives to warfarin therapy, specifically in patients with atrial fibrillation on hemodialysis for ESRD who are at increased risk for calciphylaxis, is discussed. Specifically, the left atrial appendage occluder device is described and the need for interdisciplinary management of these patients is stressed.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Calciphylaxis in the Setting of Hemodialysis, Liver Cirrhosis, and Warfarin Therapy for Atrial Fibrillation: An Argument for Alternative Anti-Embolic Therapy

Davis

et al. 2020

Cureus

“…As a result of fixed dosing, no need for routine laboratory monitoring, few drug interactions, at least equal efficacy to vitamin K antagonists and lower risks of bleeding, DOACs (dabigatran, apixaban, rivaroxaban and edoxaban) have become the oral anticoagulants of choice in several conditions, including AF, in the general population and patients with mild to moderate CME: Renal medicine CKD. 3,4,7,21 However, all DOACs have an element of renal excretion. Although patients with advanced CKD/ESKD have been generally excluded from the large DOAC clinical trials, 3 on the basis of pharmacological modelling, rivaroxaban, apixaban and edoxaban have been approved for use in Europe for patients with severe CKD ( Table 2 ).…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

Anticoagulant strategies for the patient with chronic kidney disease

et al. 2020

Chronic kidney disease (CKD) is a global health problem affecting up to 14% of the adult population in developed countries. On the basis of current guidelines, patients with CKD will often fulfi l criteria for both short-term and long-term anticoagulation. Paradoxically, patients with CKD are not only at a higher risk of thrombosis, they are also at increased risk of bleeding. Furthermore, the pharmacokinetics and pharmacodynamics of many anticoagulant therapies are signifi cantly affected by renal dysfunction. In addition, patients with advanced CKD are often systematically excluded from major clinical trials. As such, the decision on whether to anticoagulate or not, and if so with what agent, poses signifi cant challenges. A solid understanding of the condition in question and the available treatments is required to make an informed judgement call. An in-depth appreciation of the advantages and disadvantages of the currently available anticoagulants is a key element in the decision-making process.

“…Наличие ХБП является независимым фактором риска развития нарушений мозгового кровообращения: существует линейная взаимосвязь между значениями расчетной скорости клубочковой фильтрации (рСКФ) и риском инсульта -с каждым снижением показателя почечной функции на 10 мл/мин/1,73 м 2 вероятность возникновения указанного осложнения увеличивается на 7% [18]; похожие ассоциации описаны для альбуминурии [15]. Также на фоне снижения функции почек отмечается соразмерное увеличение риска крупных кровотечений при назначении антикоагулянтов пациентам с ФП: в регистре ORBIT-AF их частота составила 2,7% у пациентов без ХБП и смерти от всех причин [3].…”

Section: нарушение функции почек как предиктор неблагоприятных исходоunclassified

“…в виде интерстициального фиброза и апоптоза кардио миоцитов в предсердиях путем активации ренинангиотензин-альдостероновой системы [12], а также с процессами воспаления [13] и оксидативного стресса [3]. Также в качестве потенциальных механизмов возникновения ФП обсуждаются нарушения минерального обмена и электролитного баланса, увеличение активности симпатической нервной системы и субклиническая гиперволемия [14,15]. Реализация всех этих механизмов происходит на фоне воздействия общих для возникновения ФП и ХБП клинических состояний (рис.…”

unclassified

New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction

2020

Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and interrelated diseases, the combination of which is associated with a poor prognosis. The efficacy and safety of direct oral anticoagulants (DOACs) used to prevent thromboembolic complications of AF may depend on renal function due to the specific pharmacokinetics of these drugs. This review considers current data on the role of kidneys in the pathogenesis of ischemic and bleeding events, methods of renal function assessment and related classification issues, as well as comparison of warfarin and DOAC therapy, in patients with AF and renal dysfunction of different stages based on the results of randomized controlled trials and actual clinical practice. DOAC use in the context of dynamic deterioration of renal function, supranormal renal function, and their effect on renal outcomes is discussed. International guidelines on anticoagulant therapy in AF and renal dysfunction were analyzed.