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Editorial |

Treatment of Atrial Fibrillation in Patients With Chronic Kidney Disease: Is Stroke Prevention Worth the Risk?

Farhan Shahid, MRCP; Eduard Shantsila, PhD; Gregory Y.H. Lip, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: G. Y. H. L. has participated in guideline membership/reviewing for various guidelines and position statements from ESC, EHRA, NICE etc; steering committees/trials, including steering committees for various phase II and III studies, Health Economics & Outcomes Research, etc; investigator in various clinical trials in cardiovascular disease, including those on antithrombotic therapies in atrial fibrillation, acute coronary syndrome, lipids, etc; consultant for Bayer/Jensen J&J, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo; speaker for Bayer/Jensen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi-Sankyo. None declared (F. S., E. S.).

CORRESPONDENCE TO: Gregory Y. H. Lip, MD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, United Kingdom


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):891-892. doi:10.1016/j.chest.2015.09.026
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Atrial fibrillation (AF) and chronic kidney disease (CKD) commonly coexist in the same patient, and presence of AF does increase the relative risk of stroke in patients with CKD at least to the same extent as in those with normal renal function. Based on these considerations, stroke prevention with oral anticoagulation (OAC) appears essential in patients with AF and CKD. However, patients with CKD also have a higher risk of both intracranial and extracranial haemorrhage. A delicate balance is therefore needed to shift the overall risk-to-benefit ratio toward stroke prevention with minimal possible risk of harm from serious bleeding with OAC use. However, do we have sufficient evidence to suggest best practice in these settings? Unfortunately, there are no clinical trials to unambiguously answer this important question and insight from observational studies and meta-analyses are important.

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