TRATAMENTUL ANTICOAGULANT ÎN FIBRILAŢIE ATRIALĂ ASOCIATĂ CU BOALĂ CRONICĂ DE RINICHI.

Chronic anticoagulant treatment in patients with nonvalvular AF that also have renal failure is an important issue in therapeutic practice. About 1/3 of AF patients have a chronic renal disease (CKD stage 3 or higher) and 15% of CKD patients develop AF. CKD patients with varying degrees of renal dysfunction and nonvalvular AF have an increased risk of AVC and also of bleeding, both spontaneously and under anticoagulant treatment. This paper analyses: 1) the relationship between CKD (stages 3,4 and 5) and AF; 2) the implications of this association on embolic and hemorrhagic risk; 3) the results of the main studies on chronic treatment with antivitamins K (AVK) and the new oral anticoagulants (NOAC) in nonvalvular AF with CKD. For chronic anticoagulant treatment in AF, AVK remain the therapeutic agents with the broadest indications, irrespective of the degree of renal dysfunction. Benefits of AVC prevention are above hemorrhagic risk with correct monitoring. The new oral anticoagulants (dabigatran, rivaroxabam, apixaban) have similar indications as AVK in AVC prevention in AF, but their use is limited in severe renal dysfunction (GFR =30 ml/min). For AF patients with CKD-stage 2 and 3, NOAC have equal or superior antithrombotic efficiency compared with AVK, but significantly less thrombotic risk. The selection of patients for one or the other oral anticoagulant treatment for non-valvular AAF can be achieved on the base of risk scores (CHADS2, HASBLED), but also based on the other individual factors, among which the presence of moderate or severe renal dysfunction is a major one. [ABSTRACT FROM AUTHOR]