Name:
Anticoagulation and Chronic Renal Disease
Description:
Anticoagulation and Chronic Renal Disease
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/aa292d32-06ed-45fb-bda7-7ddb93fb894c/thumbnails/aa292d32-06ed-45fb-bda7-7ddb93fb894c.jpeg?sv=2019-02-02&sr=c&sig=VeoNMhQvAu%2BT%2FMGoOR586nN%2B4ySu%2FXBEx7gI%2FWGLn%2Fk%3D&st=2024-12-22T05%3A52%3A32Z&se=2024-12-22T09%3A57%3A32Z&sp=r
Duration:
T00H04M46S
Embed URL:
https://stream.cadmore.media/player/aa292d32-06ed-45fb-bda7-7ddb93fb894c
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/aa292d32-06ed-45fb-bda7-7ddb93fb894c/18778974.mp3?sv=2019-02-02&sr=c&sig=FT6F316nUmtj7z7s%2BqLSoIRDxFFulWqj46MI76ipJQY%3D&st=2024-12-22T05%3A52%3A32Z&se=2024-12-22T07%3A57%3A32Z&sp=r
Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's the Heart Board Review and other online resources available only through accesscardiology.com. >> The elderly population of patients represents treatment challenges in cardiovascular disease. And that's usually because of the comorbidities. What about chronic renal disease and its effects? Hi, Dr. Bernie here, and welcome to Practice Impact Extra.
As cardiologists, we are challenged by our aging population with atrial fibrillation and risks and benefits of anticoagulation. These elderly patients often have comorbidities, in particular, renal and hepatic dysfunction, which can lead to increased medication treatment risks. Clinical database, real-world experience data, and a few studies have provided evidence addressing safety and efficacy of the vitamin K antagonist warfarin versus the NOAC in patients with decreased kidney function.
Three NOACs, dabigatran, apixaban, and rivaroxaban, are renally excreted, affecting efficacy and possible bleeding risk. Therefore, choice and dosing needs to be patient-specific. As you know, 80% of dabigatran is excreted in the kidneys, 36% of rivaroxaban is excreted by the kidneys, and 27% of apixaban is excreted by the kidneys. A Mayo Clinic study published in JACC presented the results of patients with atrial fibrillation taking oral anticoagulation.
They found that NOACs as a group was associated with less injury to the kidneys than warfarin. What about the comparative safety and efficacy of oral anticoagulants across a range of renal function in patients with atrial fibrillation? A study published in Cardiology Circulation aimed to compare oral anticoagulation across a range of kidney function in patients with atrial fibrillation. So, 34,000 patient claims were linked with laboratory data of new users of an oral anticoagulant with atrial fibrillation and estimated GFRs between 15 to 30 milliliters per minute to a range of 89 milliliters per minute.
There was no -- there was a lack of evidence for GFR in patients who had renal function with a GFR of less than 15. What did they find? In comparison to warfarin, apixaban was associated with a lower risk of stroke, major bleeding, and mortality versus warfarin. Rivaroxaban was associated with a lower risk of stroke, major bleeding, and mortality versus warfarin.
Dabigatran was associated with a similar risk of stroke, but had a lower risk of major bleeding and mortality versus warfarin. It didn't appear that there was any significant interaction between treatment and GFR. When comparing one NOAC to another, there were no significant differences in mortality, but certainly some differences existed between stroke and major -- and major bleeding. What's my precautionary take-home message?
It's necessary to assess renal function before beginning a NOAC. Choose an appropriate NOAC based on renal function. Dose appropriate. For apixaban, the ABC, assess age, body weight, and creatinine clearance. You need to monitor renal function frequently, and the degree of baseline dysfunction should determine that frequency. Assess drug reactions that could affect the metabolism of the NOAC.
With careful select and monitoring of appropriate patients with atrial fibrillation, there may be advantages to NOAC treatment in patients with reduced renal function. Thank you for joining me, and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to Access Cardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features.
To subscribe or learn more, please visit accesscardiology.com.
