• Yee C Lau, Marco Proietti, Elisa Guiducci, Andrew D Blann, and Lip Gregory Y H GYH University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit,.
• University of Birmingham Institute of Cardiovascular Sciences, Birmingham City Hospital, Birmingham, United Kingdom.
• J. Am. Coll. Cardiol. 2016 Sep 27; 68 (13): 1452-1464.

AbstractA bidirectional relationship exists between atrial fibrillation (AF) and chronic renal disease. Patients with AF have a higher incidence of renal dysfunction, and the latter predisposes to incident AF. The coexistence of both conditions results in a higher risk for thromboembolic-related adverse events but a paradoxical increased hemorrhagic risk. Oral anticoagulants (both vitamin K antagonists [VKAs] and non-VKA oral anticoagulants [NOACs]) have been demonstrated to be effective in mild to moderate renal dysfunction. Patients with severe renal impairment were excluded from the non-VKA oral anticoagulant trials, so limited data are available. In end-stage renal failure, the net clinical benefit of VKAs in dialysis-dependent patients remains uncertain, although some evidence suggests that such patients may do well with high-quality anticoagulation control. Risk stratification and careful follow-up of such patients are necessary to ensure a net clinical benefit from thromboprophylaxis.Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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