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Non-valvular atrial fibrillation in CKD : role of vitamin K antagonists and direct oral anticoagulants. A narrative review

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Non-valvular atrial fibrillation in CKD : role of vitamin K antagonists and direct oral anticoagulants. A narrative review

dc.contributor.author	Cases, Aleix
dc.contributor.author	Gómez Fernández, Pablo
dc.contributor.author	Broseta, José Jesús
dc.contributor.author	Pérez Bernat, Elisa
dc.contributor.author	de Dios Arjona Barrionuevo, Juan
dc.contributor.author	Portolés Pérez, José María
dc.contributor.author	Górriz Teruel, Jose Luis
dc.date.accessioned	2022-06-15T14:07:12Z
dc.date.available	2022-06-15T14:07:12Z
dc.date.issued	2021
dc.identifier.citation	Cases, Aleix Gómez Fernández, Pablo Broseta, José Jesús Pérez Bernat, Elisa de Dios Arjona Barrionuevo, Juan Portolés Pérez, José María Górriz Teruel, Jose Luis 2021 Non-valvular atrial fibrillation in CKD : role of vitamin K antagonists and direct oral anticoagulants. A narrative review Frontiers In Medicine
dc.identifier.uri	https://hdl.handle.net/10550/83157
dc.description.abstract	Atrial fibrillation (AF) is the most common arrhythmia in chronic kidney disease (CKD), with a close bidirectional relationship between the two entities. The presence of CKD in AF increases the risk of thromboembolic events, mortality and bleeding. Vitamin K antagonists (VKA) have been the mainstay of treatment for the prevention of thromboembolic events in AF until recently, with confirmed benefits in AF patients with stage 3 CKD. However, the risk-benefit profile of VKA in patients with AF and stages 4-5 CKD is controversial due to the lack of evidence from randomized controlled trials. Treatment with VKA in CKD patients has been associated with conditions such as poorer anticoagulation quality, increased risk of bleeding, faster progression of vascular/valvular calcification and higher risk of calciphylaxis. Direct oral anticoagulants (DOACs) have shown equal or greater efficacy in stroke/systemic embolism prevention, and a better safety profile than VKA in post-hoc analysis of the pivotal randomized controlled trials in patients with non-valvular AF and stage 3 CKD, yet evidence of its risk-benefit profile in more advanced stages of CKD is scarce. Observational studies associate DOACs with a good safety/effectiveness profile compared to VKA in non-dialysis CKD patients. Further, DOACs have been associated with a lower risk of acute kidney injury and CKD development/progression than VKA. This narrative review summarizes the evidence of the efficacy and safety of warfarin and DOACs in patients with AF at different CKD stages, as well as their effects on renal function, vascular/valvular calcification and bone health.
dc.language.iso	eng
dc.relation.ispartof	Frontiers In Medicine, 2021
dc.subject	Anticoagulants (Medicina)
dc.subject	Insuficiència renal crònica
dc.subject	Arítmia
dc.title	Non-valvular atrial fibrillation in CKD : role of vitamin K antagonists and direct oral anticoagulants. A narrative review
dc.type	journal article	es_ES
dc.date.updated	2022-06-15T14:07:12Z
dc.identifier.doi	10.3389/fmed.2021.654620
dc.identifier.idgrec	154213
dc.rights.accessRights	open access	es_ES