Cited by 195Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

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Severe Renal Impairment and Stroke Prevention in Atrial Fibrillation

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Marinigh, Ricarda, Lane, Deirdre A., Lip, Gregory Y.H.·2011·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2010.12.013

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Abstract

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.

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Authors: Marinigh, R., Lane, D. A., & Lip, G. Y. H.
Affiliations: University of Trieste (IT)
Birmingham City Hospital (GB)
Corresponding author: Lip, Gregory Y.H.
ORCID: Lane, Deirdre A.
Lip, Gregory Y.H.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2011-03
Volume: 57
Issue: 12
Pages: 1339-1348
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2010.12.013
OpenAlex: W2163399076
Cited by: 195
References: 79
Citations by year: 2026: 2 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 13 · 2020: 7 · 2019: 12 · 2018: 11 · 2017: 12 · 2016: 18 · 2015: 18 · 2014: 25 · 2013: 35 · 2012: 25
FWCI: 4.98
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 905 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders: Bayer Healthcare
AstraZeneca
Boehringer
Bayer
Pfizer/BMS
Biotronic
Astellas
Sanofi
Cardiome
Merck
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords: atrial fibrillation, severe renal impairment, end-stage renal disease, stroke prevention, oral anticoagulation, hemodialysis, major bleeding, stroke risk stratification, INR monitoring, hypercoagulability
MeSH terms: Algorithms, Anticoagulants, Atrial Fibrillation, Renal Dialysis, Hemorrhage, Humans, Kidney Failure, Chronic, Thromboembolism, Comorbidity, Risk Assessment, Stroke

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Severe Renal Impairment and Stroke Prevention in Atrial Fibrillation

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