Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation

• The decision to initiate OAT poses a clinical conundrum in patients with coexisting AF and advanced CKD.
• In CKD, several pathophysiological factors result in a progressively increased risk of both ischemic stroke and hemorrhage as renal function declines, irrespective of OAT.
• The limited available data suggests that DOACs should generally be favored over VKAs in view of their probable increased safety and efficacy in CKD, with a lower risk of vascular calcification and anticoagulant-associated nephropathy.
• Until dedicated RCTs are completed to define optimal management, clinical decision-making should be informed by the limited data available, which necessitates individualization and physician-patient collaboration.