Renal Function Considerations for Stroke Prevention in Atrial Fibrillation

John Fanikos, Allison E. Burnett, Charles E. Mahan, Paul P. Dobesh

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants (DOACs) have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, DOACs were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in nonvalvular atrial fibrillation patients with mild or moderate renal impairment. Renal function decrease appears less impacted by DOACs, which are associated with a better risk-benefit profile than warfarin in patients with decreasing renal function over time. Limited data address the risk-benefit profile of DOACs in patients with severe impairment or on dialysis.

Original languageEnglish (US)
Pages (from-to)1015-1023
Number of pages9
JournalAmerican Journal of Medicine
Issue number9
StatePublished - Sep 2017


  • Atrial fibrillation
  • Direct oral anticoagulants

ASJC Scopus subject areas

  • General Medicine


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