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Int J Cardiol. 2019 Jan 1;274:179-185. doi: 10.1016/j.ijcard.2018.07.066. Epub 2018 Sep 1.

Haemorragic and thromboembolic risk in CKD patients with non valvular atrial fibrillation: Do we need a novel risk score calculator?

Author information

1
Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy. Electronic address: maura.ravera@hsanmartino.it.
2
Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy.
3
Department of Nephrology and Dialysis, Ospedale Sant'Anna, ASST-Lariana, Como, Italy.
4
Department of Nephrology and Dialysis, Parodi-Delfino Hospital, Colleferro, Italy.
5
National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy, Department of Medicine, University of Padova, Italy. Electronic address: dante.lucia@libero.it.

Abstract

Non valvular atrial fibrillation (NVAF) is highly prevalent among chronic kidney disease (CKD) patients in whom it portends increased risk for subsequent stroke or systemic thromboembolic events. For these high risk patients oral anticoagulation is recommended, after proper assessment of both thromboembolic and bleeding risk is accurately ascertained. However, current NVAF risk scores are inadequate for use in CKD subjects, since they do not take into account the occurrence and the degree of renal function impairment. Aim of this review was therefore to provide the reader with an analytical review of each risk factor included in the available risk scores systems, as well as the evaluation of the accuracy of currently adopted score systems for either bleeding or ischemic event risk prediction in patients with CKD. On the basis of available data from literature, reclassifying those patients categorized at low-risk, for whom the presence of renal impairment may be the only predictor for future adverse events emerges as a compelling unmet need. Accordingly, a new risk score calculator, specific for CKD patients is also provided.

KEYWORDS:

Albuminuria; Atrial fibrillation; Bleeding risk scores; Chronic kidney disease; Oral anticoagulation; Thromboembolic risk scores

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