Incidence of chronic kidney disease in patients with atrial fibrillation and its relevance for prescribing new oral antithrombotic drugs.

摘要

Atrial fibrillation (AF) is one of the major indications for therapy with direct thrombin (dabigatran etexilate) or factor Xa inhibitors (rivaroxaban). Both Dabigatran (80%) and Rivaroxaban (65%) are primarily excreted via the kidney [1]. Therefore, prescribing these drugs in patients with chronic kidney disease (CKD) could lead to accumulation and hence potentially to more bleeding complications [2]. Importantly, patients with an estimated glomerular filtration rate (eGFR) of < 30 mL min~-1 have been excluded from trials with new antithrombotics [2-4]. However, patients with severe CKD are at increased risk of AF due to structural and electrical atrial remodeling [5,6]. Dabigatran has been approved by the Food and Drug Administration in an oral dose of 150 mg twice daily in AF patients with eGFR > 30 mL min~-1 and in a dose of 75 mg twice daily in patients with eGFR 15-30 mL min~-1 [7].