Nonvitamin K-dependent oral anticoagulants (NOACs) in chronic kidney disease patients with atrial fibrillation
Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT...
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| Vydané v: | Thrombosis research Ročník 155; s. 38 - 47 |
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| Hlavní autori: | , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
Elsevier Ltd
01.07.2017
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| ISSN: | 0049-3848, 1879-2472, 1879-2472 |
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| Abstract | Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract.
Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients.
A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials.
This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15–49ml/min) and those on dialysis.
•Atrial fibrillation is the most common arrhythmia in patients with chronic kidney disease (CKD)•The use of NOACs in CKD is limited by the drug accumulation but it ‘s becoming more common even in subjects with advanced CKD•Preliminary data support efficacy and safety of NOACs in CKD, although further efforts are needed to evaluate safety profile in ESRD patients•The development of specific antidotes for NAOC as well as results of ongoing trials may allow larger use of these drugs in patients with advanced CKD |
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| AbstractList | Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15-49ml/min) and those on dialysis. Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15–49ml/min) and those on dialysis. •Atrial fibrillation is the most common arrhythmia in patients with chronic kidney disease (CKD)•The use of NOACs in CKD is limited by the drug accumulation but it ‘s becoming more common even in subjects with advanced CKD•Preliminary data support efficacy and safety of NOACs in CKD, although further efforts are needed to evaluate safety profile in ESRD patients•The development of specific antidotes for NAOC as well as results of ongoing trials may allow larger use of these drugs in patients with advanced CKD Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15-49ml/min) and those on dialysis.Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15-49ml/min) and those on dialysis. Abstract Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance < 25 ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15–49 ml/min) and those on dialysis. |
| Author | Campana, C. Di Iorio, B. Di Lullo, L. De Pascalis, A. Santoboni, F. Russo, D. Ronco, C. Russo, L. Barbera, V. Vitaliano, E. Galliani, M. Bellasi, A. Cozzolino, M. |
| Author_xml | – sequence: 1 givenname: L. surname: Di Lullo fullname: Di Lullo, L. email: dilulloluca69@gmail.com organization: Department of Nephrology and Dialysis, Parodi – Delfino Hospital, Colleferro, Italy – sequence: 2 givenname: C. surname: Ronco fullname: Ronco, C. organization: International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy – sequence: 3 givenname: M. surname: Cozzolino fullname: Cozzolino, M. organization: Department of Health Sciences, Renal Division, S. Paolo Hospital, Milano, Italy – sequence: 4 givenname: D. surname: Russo fullname: Russo, D. organization: Division of Nephrology, University Federico II, Napoli, Italy – sequence: 5 givenname: L. surname: Russo fullname: Russo, L. organization: Division of Nephrology, University Federico II, Napoli, Italy – sequence: 6 givenname: B. surname: Di Iorio fullname: Di Iorio, B. organization: Department of Nephrology and Dialysis, Landolfi Hospital, Solofra, Italy – sequence: 7 givenname: A. surname: De Pascalis fullname: De Pascalis, A. organization: Department of Nephrology and Dialysis, V. Fazzi Hospital, Lecce, Italy – sequence: 8 givenname: V. surname: Barbera fullname: Barbera, V. organization: Department of Nephrology and Dialysis, Parodi – Delfino Hospital, Colleferro, Italy – sequence: 9 givenname: M. surname: Galliani fullname: Galliani, M. organization: Department of Nephrology and Dialysis, S. Pertini Hospital, Roma, Italy – sequence: 10 givenname: E. surname: Vitaliano fullname: Vitaliano, E. organization: Department of Nephrology and Dialysis, S. Pertini Hospital, Roma, Italy – sequence: 11 givenname: C. surname: Campana fullname: Campana, C. organization: Cardiology Unit, S. Anna Hospital, ASST - Lariana, Como, Italy – sequence: 12 givenname: F. surname: Santoboni fullname: Santoboni, F. organization: Department of Nephrology and Dialysis, Parodi – Delfino Hospital, Colleferro, Italy – sequence: 13 givenname: A. surname: Bellasi fullname: Bellasi, A. organization: Nephrology Unit, S. Anna Hospital, ASST - Lariana, Como, Italy |
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| Keywords | Warfarin Chronic kidney disease Anticoagulation therapy Nonvitamin K-dependent oral anticoagulants (NOACs) Atrial fibrillation |
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| Snippet | Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF... Abstract Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD... |
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| SubjectTerms | Administration, Oral Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - pharmacokinetics Anticoagulants - therapeutic use Anticoagulation therapy Atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Chronic kidney disease Dabigatran - administration & dosage Dabigatran - adverse effects Dabigatran - pharmacokinetics Dabigatran - therapeutic use Hematology, Oncology and Palliative Medicine Hemorrhage - chemically induced Humans Nonvitamin K-dependent oral anticoagulants (NOACs) Prospective Studies Pyrazoles - administration & dosage Pyrazoles - adverse effects Pyrazoles - pharmacokinetics Pyrazoles - therapeutic use Pyridines - administration & dosage Pyridines - adverse effects Pyridines - pharmacokinetics Pyridines - therapeutic use Pyridones - administration & dosage Pyridones - adverse effects Pyridones - pharmacokinetics Pyridones - therapeutic use Renal Insufficiency, Chronic - complications Rivaroxaban - administration & dosage Rivaroxaban - adverse effects Rivaroxaban - pharmacokinetics Rivaroxaban - therapeutic use Stroke - etiology Stroke - prevention & control Thiazoles - administration & dosage Thiazoles - adverse effects Thiazoles - pharmacokinetics Thiazoles - therapeutic use Thromboembolism - etiology Thromboembolism - prevention & control Warfarin Warfarin - administration & dosage Warfarin - adverse effects Warfarin - pharmacokinetics Warfarin - therapeutic use |
| Title | Nonvitamin K-dependent oral anticoagulants (NOACs) in chronic kidney disease patients with atrial fibrillation |
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