Abstract
New anticoagulants represent one of the most prominent pharmacotherapeutic innovations of recent years and, in certain indications, they tend to replace the original gold standard - i.e. coumarins (the most common of which being warfarin in our practice). However, renal functions need to be taken into account when initiating and conducting any therapy with new anticoagulants.
It has been shown that about one third of patients with atrial fibrillation suffers from significant kidney disease and that the prevalence of atrial fibrillation increases with further progression of renal insufficiency. Renal impairment is a risk factor of thromboembolic events but, at the same time, it increases the risk of bleeding.
While warfarin therapy is risky in general, specific risks of this therapy are present in patients with renal impairment - i.e. vascular calcifications, calciphylaxis, and warfarin-induced nephropathy (quite recently described complication). Bearing these risks in mind, many patients with severe renal insufficiency and atrial fibrillation are being left without effective anticoagulation.
New anticoagulants could, even in patients with severe renal insufficiency, offer a more effective and less dangerous way to prevent thromboembolic complications.