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Novel oral anticoagulants in chronic kidney disease: ready for prime time?
Purpose of review Patients with chronic kidney disease (CKD) are at increased risk of atrial fibrillation, stroke, and bleeding posing unique clinical challenges. Novel oral anticoagulants (NOACs) including dabigatran, rivaroxaban, and apixaban have become recognized as alternative therapy to Vitamin K Antagonists (VKA) regarding the prevention of venous thromboembolism (VTE) and reduce the risk of stroke in atrial fibrillation. However, the understanding of NOACs in CKD is still underdeveloped. This review summarizes recent literature on the efficacy and safety of NOACs in patients with CKD. Recent findings Studies f...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Evaluation of clinical outcomes among nonvalvular atrial fibrillation patients treated with rivaroxaban or warfarin, stratified by renal  function
.
CONCLUSION: Rivaroxaban-treated NVAF patients with diagnosed renal dysfunction had a significantly lower stroke rate compared to warfarin-treated patients. Regardless of renal dysfunction diagnoses, rivaroxaban users had lower thromboembolic event rates compared to warfarin users, and a similar rate of major bleeding. eCrCl-based analysis was limited by a small sample size. PMID: 29231162 [PubMed - as supplied by publisher]
Source: Clinical Nephrology - December 12, 2017 Category: Urology & Nephrology Authors: Weir MR, Haskell L, Berger JS, Ashton V, Laliberté F, Crivera C, Brown K, Lefebvre P, Schein J Tags: Clin Nephrol Source Type: research

Warfarin Use And the Risk Of Stroke, Bleeding, And Mortality In Older Adults On Dialysis With Incident Atrial Fibrillation
Nephrology,Volume 0, Issue ja, -Not available-.
Source: Nephrology - December 8, 2017 Category: Urology & Nephrology Authors: Jingwen Tan ScM, PhD , Sunjae Bae KMD, MPH , Jodi B. Segal MD, MPH , Junya Zhu PhD , G. Caleb Alexander MD, MS , Dorry L. Segev MD, PhD , Mara McAdams ‐DeMarco PhD Source Type: research

Oral Anticoagulants to Prevent Stroke in Nonvalvular Atrial Fibrillation in Patients With CKD Stage 5D: An NKF-KDOQI Controversies Report
Publication date: Available online 21 September 2017 Source:American Journal of Kidney Diseases Author(s): Vinod K. Bansal, Charles A. Herzog, Mark J. Sarnak, Michael J. Choi, Ravindra Mehta, Bernard G. Jaar, Michael V. Rocco, Holly Kramer Stroke risk may be more than 3-fold higher among patients with chronic kidney disease stage 5D (CKD-5D) compared to the general population, with the highest stroke rates noted among those 85 years and older. Atrial fibrillation (AF), a strong risk factor for stroke, is the most common arrhythmia and affects >7% of the population with CKD-5D. Warfarin use is widely acknowledged as...
Source: American Journal of Kidney Diseases - September 21, 2017 Category: Urology & Nephrology Source Type: research

Stroke in patients with chronic kidney disease & #8230;: How do we approach and manage it ?
This article is a review of stroke in patients with CKD and approach to managing it.
Source: Indian Journal of Nephrology - May 3, 2017 Category: Urology & Nephrology Authors: S Nayak-Rao MP Shenoy Source Type: research

Recent Advances in Stroke Prevention in Patients with Atrial Fibrillation and End-Stage Renal Disease
Background: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain.Summary: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA. Limited data fr...
Source: Cardiorenal Medicine - April 26, 2017 Category: Urology & Nephrology Source Type: research

Association of CKD with Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.
CONCLUSIONS: This analysis illustrates for the first time on a nationwide basis the association of CKD with adverse outcomes in patients who underwent transcatheter aortic valve implantation. Thus, classification of CKD stages before transcatheter aortic valve implantation is important for appropriate risk stratification. PMID: 28289067 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - March 12, 2017 Category: Urology & Nephrology Authors: Lüders F, Kaier K, Kaleschke G, Gebauer K, Meyborg M, Malyar NM, Freisinger E, Baumgartner H, Reinecke H, Reinöhl J Tags: Clin J Am Soc Nephrol Source Type: research

Dual Antiplatelet Therapy and Clinical Outcomes after Coronary Drug-Eluting Stent Implantation in Patients on Hemodialysis.
CONCLUSIONS: Our findings support that the clinical effectiveness of extended DAPT in a hemodialysis population may be tempered after 6 months post-DES implantation. PMID: 28174317 [PubMed - in process]
Source: Clinical Journal of the American Society of Nephrology : CJASN - February 6, 2017 Category: Urology & Nephrology Authors: Chen YT, Chen HT, Hsu CY, Chao PW, Kuo SC, Ou SM, Shih CJ Tags: Clin J Am Soc Nephrol Source Type: research

Treatment of atrial fibrillation with warfarin among older adults with end stage renal disease.
CONCLUSION: Despite the unclear benefit and increased bleeding risk of warfarin treatment in patients with ESRD, 1 in 8 older adults undergoing dialysis with incident AF in the US who had high risk of bleeding used warfarin. Changes to warfarin therapy due to discontinuation were common after initiation. PMID: 28120282 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - January 23, 2017 Category: Urology & Nephrology Authors: Tan J, Bae S, Segal JB, Zhu J, Segev DL, Alexander GC, McAdams-DeMarco M Tags: J Nephrol Source Type: research

Warfarin Initiation, Atrial Fibrillation, and Kidney Function:  Comparative Effectiveness and Safety of Warfarin in Older Adults With Newly Diagnosed Atrial Fibrillation
Conclusions Among older adults with AF, warfarin therapy initiation was associated with a significantly lower 1-year risk for the composite outcome across all strata of kidney function. The risk for major bleeding associated with warfarin use was increased only among those with eGFRs of 60 to 89mL/min/1.73m2.
Source: American Journal of Kidney Diseases - December 18, 2016 Category: Urology & Nephrology Source Type: research

New oral anticoagulants in patients with chronic kidney disease.
Authors: Belmar Vega L, de Francisco AL, Bada da Silva J, Galván Espinoza L, Fernández Fresnedo G Abstract Patients with chronic kidney disease (CKD) develop bleeding and thrombotic tendencies, so the indication of anticoagulation at the onset of atrial fibrillation (AF) is complex. AF is the most common chronic cardiac arrhythmia, and thromboembolism and ischemic stroke in particular are major complications. In recent years, new oral anticoagulant drugs have been developed, and they have shown superiority over the classical AVK in preventing stroke, systemic embolism and bleeding risk, constituting an effective ...
Source: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia - December 14, 2016 Category: Urology & Nephrology Tags: Nefrologia Source Type: research

Antiplatelet agents in hemodialysis.
In conclusion, since CRF patients are one of the groups at highest risk for atherosclerotic events, it could be reasonable to use aspirin in HD patients. However, the bleeding risk in HD patients needs to be strongly evaluated, especially before starting dual AA treatment. PMID: 27928736 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - December 7, 2016 Category: Urology & Nephrology Authors: Migliori M, Cantaluppi V, Scatena A, Panichi V Tags: J Nephrol Source Type: research

The effects of vitamin K supplementation and vitamin K antagonists on progression of vascular calcification: ongoing randomized controlled trials
Conclusion Vitamin K deficiency may be a modifiable cardiovascular risk factor in the haemodialysis population. Conversely, vitamin K antagonists may aggravate VC burden in haemodialysis patients. Several ongoing trials may provide an answer to these questions in the near future.
Source: CKJ: Clinical Kidney Journal - March 15, 2016 Category: Urology & Nephrology Authors: Caluwe, R., Pyfferoen, L., De Boeck, K., De Vriese, A. S. Tags: CKD-MBD Source Type: research

Peri-procedural management of patients taking oral anticoagulants
This article will help guide physician to better provide peri-procedural management of oral anticoagulation therapy. : Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation Update in Nephrology: Evidence Published in 2010 Policy Statement of Canadian Society of Transplantation and Canadian Society of Nephrology on Organ Trafficking and Transplant Tourism
Source: Nephrology Now - September 21, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: General Nephrology Review Source Type: research

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