Pharmacokinetic and Clinical Implications of Dabigatran Use in Severe Renal Impairment for Stroke Prevention in Nonvalvular Atrial Fibrillation

2012 ◽  
Vol 46 (7-8) ◽  
pp. 1105-1110 ◽  
Author(s):  
Diana R Mack ◽  
Jenny J Kim
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Stroke Prevention ◽  
Severe Renal Impairment ◽  
Clinical Implications ◽  
Nonvalvular Atrial Fibrillation

Safety outcomes of apixaban in patients with nonvalvular atrial fibrillation and severe renal impairment

2020 ◽  
Vol 50 (2) ◽  
pp. 330-336 ◽  
Author(s):  
Maura J. Jones ◽  
Sarah T. Eudaley ◽  
Robert A. Moye ◽  
Terry A. Hodge ◽  
Ross M. Nesbit ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Severe Renal Impairment ◽  
Nonvalvular Atrial Fibrillation ◽  
Safety Outcomes

scholarly journals Severe Renal Impairment and Stroke Prevention in Atrial Fibrillation

2011 ◽  
Vol 57 (12) ◽  
pp. 1339-1348 ◽  
Author(s):  
Ricarda Marinigh ◽  
Deirdre A. Lane ◽  
Gregory Y.H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Stroke Prevention ◽  
Severe Renal Impairment

Real-world stroke prevention strategies in nonvalvular atrial fibrillation in patients with renal impairment

2017 ◽  
Vol 47 (6) ◽  
pp. 428-438 ◽  
Author(s):  
Kadir U. Mert ◽  
Gurbet Ö. Mert ◽  
Özcan Başaran ◽  
Osman Beton ◽  
Volkan Dogan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Real World ◽  
Stroke Prevention ◽  
Prevention Strategies ◽  
Nonvalvular Atrial Fibrillation

scholarly journals Safety and Efficacy of Direct Oral Anticoagulants for Atrial Fibrillation in Patients with Renal Impairment

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 30 ◽  
Author(s):  
Soo Min Jang ◽  
Khaled Bahjri ◽  
Huyentran Tran
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Bleeding Events ◽  
Nonvalvular Atrial Fibrillation ◽  
Efficacy Data ◽  
Safety And Efficacy

Direct oral anticoagulants (DOACs) are gaining popularity for patients with nonvalvular atrial fibrillation (AF) for stroke prevention. Less bleeding risk with comparable stroke prevention compared to warfarin was shown. DOACs have predictable anticoagulant effects, infrequent monitoring requirements and less drug-food interactions compared to warfarin. However, safety and efficacy data of DOACs in patients with chronic kidney disease (CKD) are limited. This is a retrospective study to evaluate thromboembolic and bleeding events in patients with AF (with/without CKD) in October 2010 and July 2017. A total of 495 patients were included and only 150 patients had CKD. Our study found that patients with renal impairment on a DOAC do not have a higher incidence of bleeding events. It showed significant increase in thromboembolic events in CKD patients with dabigatran compared to CKD patients with apixaban with odds ratio of 6.58 (95%CI 1.35–32.02, p = 0.02).

scholarly journals Renal Dysfunction, CHADS2 Score, and Adherence to the Anticoagulant Treatment in Nonvalvular Atrial Fibrillation

2016 ◽  
Vol 23 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Yihong Sun ◽  
Yitong Wang ◽  
Juan Jiang ◽  
Lina Wang ◽  
Dayi Hu
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Renal Dysfunction ◽  
Severe Renal Impairment ◽  
Chinese Patients ◽  
Anticoagulant Treatment ◽  
Nonvalvular Atrial Fibrillation ◽  
Chads2 Score ◽  
Significant Difference ◽  
The Impact

We investigated the risk of stroke associated with renal dysfunction and the impact of warfarin therapies in Chinese patients with nonvalvular atrial fibrillation (NVAF). Information was collected on age, sex, height, weight, type of atrial fibrillation, and serum creatinine within the previous 6 months, together with the variables needed to calculate the CHADS2 score. For patients not taking warfarin, reasons why not were recorded. Three thousand seventeen eligible patients with NVAF, mean (1 standard deviation [SD]) age of 67.7 (13.0) years, from 50 Chinese hospitals were included from May 2012 to October 2012, with a mean (1SD) CHADS2 score of 2.0 (1.5). Of these, 58.3% were male and 86.2% were at high risk of stroke with a CHADS2 score ≥1. Only 42.6% were on warfarin, and 22.5% of the patients had moderate or severe renal impairment (estimated glomerular filtration rate < 60 mL/min/1.73 m2). After adjustment for the CHADS2 score, renal dysfunction remained moderately but significantly associated with the risk of stroke/TIA (odds ratio = 1.005, 95% confidence interval: 1.002-1.009, P = .002). There was, however, no significant difference in anticoagulant usage between patients with or without impaired renal dysfunction. The most common anticoagulant concerns were the low proportion of patients with regular international normalized ratio monitoring (43.0%) and the risk of bleeding (33.3%). Renal impairment was common and independently associated with the risk of cerebrovascular embolism in Chinese patients with NVAF but not independently related to underuse of anticoagulant treatment.

scholarly journals Evaluation of Direct Oral Anticoagulant Prescribing in Patients With Moderate to Severe Renal Impairment

2021 ◽  
Vol 27 ◽  
pp. 107602962098790
Author(s):  
Clara Ting ◽  
Megan Rhoten ◽  
Jillian Dempsey ◽  
Hunter Nichols ◽  
John Fanikos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Impairment ◽  
Severe Renal Impairment ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Events ◽  
Increase Risk ◽  
Severe Chronic Kidney Disease ◽  
Dosing Strategies ◽  
Require Dose

Patients with renal impairment require dose adjustments for direct oral anticoagulants (DOACs), though there is uncertainty regarding their use in severe chronic kidney disease. Inappropriately dosed DOACs may increase risk of ischemic events when under-dosed, or risk of bleeding when over-dosed. The purpose of this study was to describe DOAC selection, dosing strategies, and associated clinical outcomes in patients with moderate to severe renal impairment at our institution. This was a single-center retrospective analysis of adult outpatients with moderate to severe renal impairment (estimated creatinine clearance <50 mL/min, including need for hemodialysis) who were prescribed a DOAC by a cardiologist between June 1, 2015 and December 1, 2018. Outcomes evaluated included the percentage of patients who received appropriate and inappropriate DOAC dosing, prescriber reasons for inappropriate DOAC dosing if documented, and incidence of thrombotic and bleeding events. A total of 207 patients were included. Overall, 61 (29.5%) patients received inappropriate dosing, with 43 (70.5%) being under-dosed and 18 (29.5%) being over-dosed as compared to FDA-labeled dosing recommendations for atrial fibrillation or venous thromboembolism (VTE). By a median follow-up duration of 20 months, stroke occurred in 6 (3.3%) patients receiving DOACs for atrial fibrillation, and VTE occurred in 1 (4.3%) patient receiving a DOAC for VTE. International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding occurred in 25 (12.1%) patients. Direct oral anticoagulants were frequently prescribed at off-label doses in patients with moderate to severe renal impairment, with a tendency toward under-dosing.

Sign in / Sign up

Export Citation Format

Share Document