Novel oral anticoagulants for atrial fibrillation in patients with worsening renal function

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Clinical studies suggest that at least 25% of patients with atrial fibrillation (AF) present with worsening renal function, although the rate of chronic kidney disease (CRD) occurrence and progression depend on the evaluation criteria. In patients with AF, the risk of CKD progression is higher than in patients with sinus rhythm, probably due to older age, a higher occurence of cardiovascular diseases and type 2 diabetes, hyperactivity of neurohormonal systems, changes in hemody- namics, and side effects of drug treatment. Meta-analyses of controlled clinical trials showed that novel oral anticoagulants (NOAC) in patients with AF and CKD were more effective and at least as safe as warfarin. In ROCKET AF study, treatment with rivaroxaban in patients with worsening renal function was associated with lower rates of stroke and systemic embolism compared with warfarin without an increase in the bleeding rate. Dosage of NOAC depends on renal function. Therefore, estimated creatinine clearance should be regularly monitored (at least annually) during treatment with NOAC for timely correction of prescribed dose in case of worsening renal function.

Key words

Фибрилляция предсердий, функция почек, прямые оральные антикоагулянты, ривароксабан, дабигатран, апиксабан, эдоксабан.