01640nas a2200229   4500000000100000008004100001100001300042700001400055700001200069700001700081700001600098700001200114700001400126700001500140700001900155245011000174250001500284300001200299490000700311520104100318020005101359       2016                            d1 aPatel M.1 aJardine M1 aChan K.1 aGiugliano R.1 aAbramson S.1 aZhao S.1 aMaddux F.1 aPiccini J.1 aPerkovic Vlado00aNonvitamin K Anticoagulant Agents in Patients With Advanced Chronic Kidney Disease or on Dialysis With AF  a2016/06/18  a2888-990 v673 a<p>
Nonvitamin K-dependent oral anticoagulant agents (NOACs) are currently recommended for patients with atrial fibrillation at risk for stroke. As a group, NOACs significantly reduce stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with warfarin. All NOACs are dependent on the kidney for elimination, such that patients with creatinine clearance &lt;25 ml/min were excluded from all the pivotal phase 3 NOAC trials. It therefore remains unclear how or if NOACs should be prescribed to patients with advanced chronic kidney disease and those on dialysis. The authors review the current pharmacokinetic, observational, and prospective data on NOACs in patients with advanced chronic kidney disease (creatinine clearance &lt;30 ml/min) and those on dialysis. The authors frame the evidence in terms of risk versus benefit to bring greater clarity to NOAC-related major bleeding and efficacy at preventing stroke specifically in patients with creatinine clearance &lt;30 ml/min.
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  a1558-3597 (Electronic)<br/>0735-1097 (Linking)