Antikoagulation bei chronischer Nierenkrankheit

In our increasingly ageing population, more and more people are suffering from chronic kidney disease (CKD). They represent a particularly vulnerable group of patients who are very often affected by cardiovascular comorbidities such as atrial fibrillation (AF). On the one hand, these patients are at high risk of ischaemic stroke, but on the other hand, they are also particularly prone to serious bleeding. Anticoagulation is likely to offer a benefit up to CKD stage 3, beyond which it is more likely to lead to complications in the form of serious haemorrhage. Overall, direct oral anticoagulants (DOACs) appear to be favourable compared to vitamin K antagonists (VKAs) in terms of efficacy and side effects. In clinical practice, risk-benefit analysis must be performed in each case individually and the decision has to be made together with the patient following detailed patient education. The medication, including the dosage, must be re-evaluated each time the kidney function is checked and adjusted or discontinued if necessary. Of course, alternatives such as atrial appendage occlusion should also be considered. In the future, factor XI inhibitors are likely to be a promising treatment option, although further study results are still needed.