Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist’s perspective

Ravera, Maura; Bussalino, Elisabetta; Fusaro, Maria; Lullo, Luca Di; Aucella, Filippo; Paoletti, Ernesto

doi:10.1007/s40620-020-00720-5

Cited by 14 publications

(11 citation statements)

References 127 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, AF is associated to increased mortality in this population [2]. Indeed, VKAs fail to demonstrate a clear benefit for stroke prevention in these patients, and some studies have raised concerns about the possibility that VKAs may generate more harm than benefit [3][4][5]. Moreover, dialysis patients have a higher risk of bleeding due to platelet function alterations associated with uremia [6].…”

Section: Introductionmentioning

confidence: 99%

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

et al. 2020

View full text Add to dashboard Cite

Background In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk. Methods Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n = 114) and the other not taking any OAT (no-therapy cohort, n = 148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors. Results The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients. Conclusions The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.

show abstract

Section: Introductionmentioning

confidence: 99%

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Угнетение другого белка, остеокальцина, способно приводить к снижению минеральной плотности костной ткани и теоретически увеличивать риск развития переломов среди пациентов, получающих варфарин, хотя это было продемонстрировано не во всех работах. Сообщалось также об увеличении темпов кальцификации клапанов сердца среди больных, принимающих варфарин [14].…”

Section: патофизиологические основы рисков тромбозов и кровотечений unclassified

“…Нефротоксичность варфарина заключается в возможности развития тяжелого клубочкового кровоизлияния с последующей обструкцией канальцев, а также повреждения эпителия канальцев среди пациентов, получающих избыточную дозу этого препарата [14]. Среди 15258 больных ФП, начавших прием варфарина, в течение 5 лет предполагаемая нефропатия (повышение сывороточного креатинина (СКр) на >26,5 ммоль/л в течение 1 нед.…”

Section: патофизиологические основы рисков тромбозов и кровотечений unclassified

“…замедляло риск прогрессирования дисфункции почек на ≈20% или 1,1-1,2 мл/мин в абсолютных величинах [52]. Предполагаемые механизмы этого явления включают блокаду II фактора свертывания и опосредованные ей благоприятные сосудистые эффекты в виде уменьшения явлений воспаления, оксидативного стресса, дисфункции эндотелия и объема атеросклеротических бляшек на фоне назначения дабигатрана [14,52].…”

Section: применение ппоак у пациентов с ухудшающейся функцией почекunclassified

“…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

See 2 more Smart Citations

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

2020

View full text Add to dashboard Cite

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.

show abstract

Vitamin-K-Antagonisten

Alban

2023

Klinische Angiologie

View full text Add to dashboard Cite

Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist’s perspective

Cited by 14 publications

References 127 publications

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

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

Vitamin-K-Antagonisten

Contact Info

Product

Resources

About