Anticoagulation in atrial fibrillation and co-existent chronic kidney disease: efficacy versus safety

Introduction: Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are individually associated with a higher incidence of stroke as compared with the general population. Over the last two decades, an increase in prevalence of AF is seen in patients with CKD. While long-term anticoagulation with warfarin is well established to reduce the risk of thromboembolic event in patients with AF, its safety and efficacy has not been documented in patients with severe CKD. Areas covered: In this review, the authors analyze the risk and benefit of long term anticoagulation across the spectrum of AF patients with CKD and explore the role of novel agents in this unique patient population. A Medline search of the English literature published between 1980 and 2012 was performed using the heading 'chronic kidney disease' combined with 'atrial fibrillation', 'hemodialysis', 'warfarin', 'anticoagulation' and 'new oral anticoagulants' . Expert opinion: Long-term anticoagulation with warfarin under strict monitoring appears to be the cornerstone of therapy in patients with CKD to prevent stroke. Further research is warranted to explore the safety and efficacy of newer anticoagulant agents in these high-risk patients in order to reduce the incidence of disabling stroke.