67
6.8.4. Chronic Kidney Disease/Kidney Failure
COR LOE
Recommendations
1 B-R 1. For patients with AF at elevated risk for stroke and CKD
stage 3, treatment with warfarin or, preferably, evidence-based
doses of direct thrombin or factor Xa inhibitors (Table 19) is
recommended to reduce the risk of stroke.
2a B-NR 2. For patients with AF at elevated risk for stroke and CKD
stage 4, treatment with warfarin or labeled doses of DOACs is
reasonable to reduce the risk of stroke.
2b B-NR 3. For patients with AF at elevated risk for stroke and who have
end-stage CKD (CrCl <15 mL/min) or are on dialysis, it
might be reasonable to prescribe warfarin (INR 2.0–3.0) or
evidence-based dose of apixaban for oral anticoagulation to
reduce the risk of stroke.
6.8.2. Chronic Coronary Disease (CCD)
COR LOE
Recommendation
1 B-R 1. In patients with AF and CCD (beyond 1 year after
revascularization or CAD not requiring coronary
revascularization) without history of stent thrombosis, oral
anticoagulation monotherapy is recommended over the
combination therapy of OAC and single APT (aspirin or
P2Y12 inhibitor) to decrease risk of major bleeding.
6.8.3. Peripheral Artery Disease (PAD)
COR LOE
Recommendation
2a B-NR 1. In patients with AF and concomitant stable PAD,
monotherapy oral anticoagulation is reasonable over dual
therapy (anticoagulation plus aspirin or P2Y12 inhibitors) to
reduce the risk of bleeding.
