Haemorragic and thromboembolic risk in CKD patients with non valvular atrial fibrillation: Do we need a novel risk score calculator?

Int J Cardiol. 2019 Jan 1;274:179-185. doi: 10.1016/j.ijcard.2018.07.066. Epub 2018 Sep 1.

Abstract

Non valvular atrial fibrillation (NVAF) is highly prevalent among chronic kidney disease (CKD) patients in whom it portends increased risk for subsequent stroke or systemic thromboembolic events. For these high risk patients oral anticoagulation is recommended, after proper assessment of both thromboembolic and bleeding risk is accurately ascertained. However, current NVAF risk scores are inadequate for use in CKD subjects, since they do not take into account the occurrence and the degree of renal function impairment. Aim of this review was therefore to provide the reader with an analytical review of each risk factor included in the available risk scores systems, as well as the evaluation of the accuracy of currently adopted score systems for either bleeding or ischemic event risk prediction in patients with CKD. On the basis of available data from literature, reclassifying those patients categorized at low-risk, for whom the presence of renal impairment may be the only predictor for future adverse events emerges as a compelling unmet need. Accordingly, a new risk score calculator, specific for CKD patients is also provided.

Keywords: Albuminuria; Atrial fibrillation; Bleeding risk scores; Chronic kidney disease; Oral anticoagulation; Thromboembolic risk scores.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy
  • Cause of Death / trends
  • Dose-Response Relationship, Drug
  • Follow-Up Studies
  • Global Health
  • Glomerular Filtration Rate
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology*
  • Humans
  • Incidence
  • Kidney Function Tests
  • Renal Insufficiency, Chronic / complications*
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends
  • Thromboembolism / epidemiology
  • Thromboembolism / etiology*
  • Thromboembolism / prevention & control

Substances

  • Anticoagulants