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Management of thromboembolic risk in patients with atrial fibrillation and chronic kidney disease

Warren J Manning, MD
Section Editors
Bradley P Knight, MD, FACC
Jeffrey S Berns, MD
Deputy Editors
Alice M Sheridan, MD
Gordon M Saperia, MD, FACC


The presence of either atrial fibrillation (AF) or chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, increases the risk of systemic thromboembolism and clinical embolic (ischemic) stroke. (See 'Stroke' below and "Atrial fibrillation: Risk of embolization", section on 'Epidemiology'.)

Antithrombotic therapy, which is recommended to decrease this risk for AF patients with one or more clinical risk factors for these adverse outcomes, and CKD are both associated with an increased risk of bleeding. (See 'Major bleeding' below and "Management of warfarin-associated bleeding or supratherapeutic INR", section on 'Bleeding risk'.)

Thus, the decision to recommend antithrombotic therapy for patients with AF and CKD requires consideration of the benefits and risks. This is not an uncommon issue, given the frequency of AF and CKD worldwide. Few studies have compared outcomes with different antithrombotic strategies in the subset of AF patients with CKD and, in particular, those with end-stage renal disease (ESRD), most of whom are receiving dialysis.

This topic will present an approach to antithrombotic therapy across the spectrum of CKD severity. The approach to antithrombotic therapy in the broad population of patients with AF is found elsewhere. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization".)


Estimates of the prevalence of CKD and AF, either alone or together, are as follows (table 1):

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Literature review current through: Oct 2017. | This topic last updated: Nov 17, 2016.
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