Author + information
- Received November 27, 2010
- Accepted December 9, 2010
- Published online March 22, 2011.
- ↵⁎Reprint requests and correspondence:
Prof. Gregory Y. H. Lip, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, City Hospital, Birmingham B18 7QH, United Kingdom
The prevalence of atrial fibrillation (AF) in end-stage renal failure is high, with an increased risk of stroke among these patients with AF compared with the AF population without severe renal impairment. Many trials have shown the net clinical benefit of oral anticoagulation therapy for primary and secondary prevention of stroke in patient populations with AF. However, current stroke risk stratification schemes are based on studies that have deliberately excluded patients with severe renal impairment. Indeed, there are no large randomized controlled trials that assess the real risk/benefit of full intensity anticoagulation in patients with severe renal impairment. Also, rates of major bleeding episodes in anticoagulated hemodialysis patients with AF are high. These data are influenced by the lack of appropriate monitoring, the difficulties in maintaining the international normalized ratio target (variable between the studies), and an inaccurate bleeding classification. Thus, the limited available data may be difficult to apply to such a heterogeneous patient population, characterized by both an increased risk of bleeding and a hypercoagulability state, as seen in the patient population with severe renal impairment.
- atrial fibrillation
- bleeding risk
- end-stage renal disease
- oral anticoagulation
- severe renal impairment
- stroke risk
Dr. Marinigh has reported that he has no relationships to disclose. Dr. Lane has received an investigator-initiated grant from Bayer Healthcare; has received industry-funded sponsorship to cardiology conferences; and has been on the Speakers' Bureau for Bayer Healthcare. Dr. Lip has received funding for research, educational symposia, consultancy, and lecturing from AstraZeneca, Boehringer, Bayer, Pfizer/BMS, Biotronic, Astellas, Sanofi, Cardiome, and Merck; is a clinical advisor to the UK NICE Guidelines on AF Management; and is a task force member of the 2010 ESC Guidelines and ACCP9 Writing Committee.
- Received November 27, 2010.
- Accepted December 9, 2010.
- American College of Cardiology Foundation
- Search Strategy
- Risk of Stroke in Severe Renal Impairment
- Thromboembolism in AF and Severe Renal Impairment: Pathophysiological and Clinical Observations
- Bleeding Risk in Severe Renal Impairment: Pathophysiological and Clinical Observations
- Oral Anticoagulants in Severe Renal Impairment
- Risk Stratification Schema for Stroke and Bleeding in Patients With AF and CKD