Renal Function Considerations for Stroke Prevention in Atrial Fibrillation

John Fanikos; Allison E Burnett; Charles E Mahan; Paul P Dobesh

doi:10.1016/j.amjmed.2017.04.015

Renal Function Considerations for Stroke Prevention in Atrial Fibrillation

Am J Med. 2017 Sep;130(9):1015-1023. doi: 10.1016/j.amjmed.2017.04.015. Epub 2017 May 11.

Authors

John Fanikos¹, Allison E Burnett², Charles E Mahan³, Paul P Dobesh⁴

Affiliations

¹ Department of Pharmacy, Brigham and Women's Hospital, Boston, Mass. Electronic address: jfanikos@partners.org.
² Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque.
³ College of Pharmacy, University of New Mexico Health Sciences Center, Presbyterian Healthcare Services, Albuquerque.
⁴ College of Pharmacy, University of Nebraska Medical Center, Omaha.

PMID: 28502818
DOI: 10.1016/j.amjmed.2017.04.015

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.

Keywords: Atrial fibrillation; Direct oral anticoagulants.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Anticoagulants / administration & dosage
Anticoagulants / adverse effects
Anticoagulants / therapeutic use*
Antithrombins / administration & dosage
Antithrombins / therapeutic use
Atrial Fibrillation / complications*
Atrial Fibrillation / drug therapy
Dabigatran / administration & dosage
Dabigatran / adverse effects
Dabigatran / therapeutic use
Embolism / complications
Embolism / etiology
Embolism / prevention & control*
Factor Xa Inhibitors / administration & dosage
Factor Xa Inhibitors / therapeutic use
Hemorrhage / etiology*
Humans
Pharmaceutical Research / methods
Pharmaceutical Research / standards
Pharmaceutical Research / statistics & numerical data
Pyrazoles / administration & dosage
Pyrazoles / adverse effects
Pyrazoles / therapeutic use
Pyridines / administration & dosage
Pyridines / adverse effects
Pyridines / therapeutic use
Pyridones / administration & dosage
Pyridones / adverse effects
Pyridones / therapeutic use
Renal Insufficiency / complications*
Risk Assessment
Rivaroxaban / administration & dosage
Rivaroxaban / adverse effects
Rivaroxaban / therapeutic use
Stroke / etiology
Stroke / prevention & control*
Therapeutic Equivalency
Thiazoles / administration & dosage
Thiazoles / adverse effects
Thiazoles / therapeutic use
Warfarin / administration & dosage
Warfarin / adverse effects
Warfarin / therapeutic use

Substances

Anticoagulants
Antithrombins
Factor Xa Inhibitors
Pyrazoles
Pyridines
Pyridones
Thiazoles
apixaban
Warfarin
Rivaroxaban
Dabigatran
edoxaban