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Anticoagulant therapy in patient with chronical kidney disease and atrial fibrillation

Esayan A. M.
Academician I. P. Pavlov First St. Petersburg State Medical University, L. Tolstogo 6/8, St.-Petersburg 197022

Keywords: chronic kidney disease, atrial fibrillation, new oral anticoagulants, rivaroxaban

DOI: 10.18087/rhfj.2017.4.2395

Chronic kidney disease (CKD) persists in every fourth patient with cardiovascular disease (CVD). The CKD is an independent risk factor for CVD and has the same high risk of cardiovascular complications as ischemic heart disease. Majority of patients with CKD do not know about serious disease and have been revealed in the terminal stage, when efforts for improvement of renal function are impossible. Therefore, it is necessary for doctors of all specialties to be informed about importance of the kidney pathology and also about simple criteria for diagnose CKD. CKD is a predisposing risk factor for atrial fibrillation (AF) along with arterial hypertension, chronic heart failure, ischemic heart disease and diabetes mellitus. Patients with AF in Russia have a high risk of stroke. Presence of CKD significantly increases this risk as well as other cardiovascular complications. New oral anticoagulants (NOAC) are the preferential choice for patients with CKD and non-valvular AF versus (over) vitamin K antagonists. Among the NOAC preference should be given to the drugs with predominantly non-renal clearance; with the best nephrologic profile and a strong evidence base; with asimple and reliable dosing algorithm for CKD; preferably, a single daily dosing. A special renal dose was studied only with rivaroxaban among NOAC in the phase III studies. The efficacy and safety of rivaroxaban for patients with CKD was proved in the comorbid population: with high risk of stroke and hemorrhage Algorithm of Rivaroxaban’s dosing is simple and provides doctors quickly right dose selection and promotes high adherence in the patient population.
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Esayan A. M. Anticoagulant therapy in patient with chronical kidney disease and atrial fibrillation. Russian Heart Failure Journal. 2017;18(4):243–252

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