Prescribing patterns of new oral anticoagulants in patients with atrial fibrillation and chronic kidney disease: A narrative review

Abstract

This study aimed to investigate the prescribing patterns of new oral anticoagulants in atrial fibrillation patients based on creatinine clearance. A thorough analysis of articles published between 2017 and 2021 in databases such as PubMed, Scopus, and Google Scholar was conducted. The review revealed distinctive features in the use of new oral anticoagulants concerning glomerular filtration rate. Apixaban was identified as a judicious choice for individuals with kidney disorders, with approximately 25% of its dose excreted in urine. American guidelines specifically recommend apixaban for those with a creatinine clearance of less than 15 mL/min, while European recommendations contraindicate all new oral anticoagulants for such rates. In instances where the glomerular filtration rate ranges from 15 to 29 mL/min, apixaban or edoxaban may be preferred due to the substantial renal elimination of edoxaban. Reduced dose regimens of rivaroxaban, edoxaban, and apixaban are advised for individuals with chronic kidney disease and a creatinine clearance between 15 and 30 mL/min. Dabigatran, characterized by an 80% renal elimination rate, is recommended for individuals with a creatinine clearance exceeding 30 ml/min according to European guidelines and those with a clearance of at least 15 ml/min according to American guidelines.