Nonvitamin K Oral Anticoagulants in Patients With Atrial Fibrillation and Severe Renal Dysfunction

Rev Esp Cardiol (Engl Ed). 2018 Oct;71(10):847-855. doi: 10.1016/j.rec.2018.05.015. Epub 2018 Jun 27.
[Article in English, Spanish]


Both atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, especially with increasing age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between both AF and CKD seems to be bidirectional: CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of stroke, mortality, cardiac events, and bleeding. Stroke prevention requires use of oral anticoagulants, which are either vitamin K antagonists (eg, warfarin), or the nonvitamin K antagonist oral anticoagulants (NOACs). While NOACs have been shown to be effective in mild-to-moderate renal dysfunction, there are a paucity of data regarding NOACs in severe and end-stage renal dysfunction. This review first discusses the evidence for NOACs in CKD. Second, we summarize the current knowledge regarding the efficacy and safety of NOACs to prevent AF-related stroke and systemic embolism in severe and end-stage renal disease.

Keywords: Anticoagulantes orales no dependientes de la vitamina K; Atrial fibrillation; Chronic kidney disease; Enfermedad renal crónica; Fibrilación auricular; Nonvitamin K antagonist oral anticoagulants.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Atrial Fibrillation* / drug therapy
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / physiopathology
  • Comorbidity
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Prognosis
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / physiopathology
  • Thromboembolism / etiology
  • Thromboembolism / prevention & control*
  • Vitamin K / antagonists & inhibitors*


  • Anticoagulants
  • Vitamin K