Atrial Fibrillation and Renal Function How High Is the Price of Anticoagulation? ∗

For over a half century, vitamin K antagonists, chiefly warfarin, were the exclusive oral anticoagulants available for long-term anticoagulation. Being “the only game in town,” the emphasis of the accompanying clinical research was focused on determining the most appropriate method to measure anticoagulant effects, define the most efficacious and safe target range for anticoagulation, and identify strategies to maintain and reverse therapeutic anticoagulation. This emphasis came at the expense of turning a blind eye to rare concerns raised about the potential for warfarin to cause or worsen renal dysfunction (1,2). The approval of dabigatran for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) ushered in a new era in long-term oral anticoagulation (3). Progress in this era has been unprecedented in recent years, and there are now several newer oral anticoagulant (NOAC) options approved by the U.S. Food and Drug Administration for clinical use (4). Interestingly, clinicians now find themselves in the relatively uncomfortable position of having to choose the “best” option among anticoagulants for their patients. The selection of the most appropriate oral anticoagulant can be a complex, multistep process that is based on the consideration of several clinical variables including, importantly, the assessment of renal function (4).

Source: Journal of the American College of Cardiology - June 8, 2015 Category: Cardiology Source Type: research