While blood thinners are widely used to prevent stroke in patients with an irregular heart rhythm, their safety in patients with severe kidney disease is still unclear, according to a recent review of existing evidence. Findings were published in the Journal of the American College of Cardiology (JACC) and suggest that treatment decisions often require an individualized approach with close doctor-patient collaboration.
Atrial fibrillation (AFib) is the most common type of abnormal heart rhythm, affecting as many as 6.1 million Americans. Since AFib drastically increases risk for stroke, blood thinners are universally recommended to help prevent blood clots and reduce risk for heart events. However, blood thinners can increase risk of bleeding, which is dangerous for individuals at high risk—including those with kidney disease.
To help provide clear recommendations for treatment, experts recently reviewed existing evidence on the topic, the results of which were published as part of the JACC Review Topic of the Week.
Overall, authors conclude that treatment recommendations depend largely on a patient’s stage of chronic kidney disease. There have been a number of clinical trials conducted in AFib patients with less advanced kidney disease, which have helped inform clear guidelines for treatment.
In patients with less advanced kidney disease (stages 1-3), studies support use of blood thinners to reduce risk of stroke. Experts also note that direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs), for number of reasons.
DOACs are a novel type of blood thinner that require less monitoring and are easier to take than VKAs like warfarin. They’ve been shown to work as well – if not better – at preventing strokes with fewer side effects. DOACs also appear safer than VKAs in patients with early stage kidney disease.
When it comes to treating AFib patients with severe kidney disease, however, recommendations are less clear. There are no clinical trials that have tested treatments in this high-risk group of patients. As a result, experts can’t make clear recommendations on the best course of treatment.
Still, there are a number of options for stroke prevention in patients with AFib and advanced kidney disease, as outlined in the recent review. According to authors, treatment options may include blood thinners or procedures to help reduce risk of stroke. Patients may also opt for no therapy if risk of complications from medication and procedures seems too high.
For those considering blood thinners, data from health registries supports DOACs over VKAs in patients with severe kidney disease. Evidence also suggests that VKAs should specifically be avoided for patients with specific risk factors that increase risk for complications.
Ultimately, however, authors note that patients with advanced stage kidney disease should work closely with their doctor to determine the best treatment option based on their health, risks factors and patient preferences.
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