Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Sep 20, 2025; 15(3): 105485
Published online Sep 20, 2025. doi: 10.5493/wjem.v15.i3.105485
Management of anticoagulation in patients with atrial fibrillation and renal dysfunction: A systematic review
Anish Kumar, Chander Kumar, Ajay Kumar, Simran Kumari, Aneela, Rahul Rai, Aman Kumar, Kapeel Kumar, Gyaneshwari, Hina Aslam, Inshal Jawed, Farah Alam, Syed Ali Farhan Abbas Rizvi, Muhammad Umair, Agha MW Mirza
Anish Kumar, Chander Kumar, Aneela, Rahul Rai, Aman Kumar, Kapeel Kumar, Gyaneshwari, Medicine, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Sindh, Pakistan
Ajay Kumar, Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Sindh, Pakistan
Simran Kumari, Medicine, Ghulam Muhammad Mahar Medical College, Sukkur 65200, Sindh, Pakistan
Hina Aslam, Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Inshal Jawed, Dow Medical College, Dow University of Health Sciences, Karachi 75350, Sindh, Pakistan
Farah Alam, Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
Syed Ali Farhan Abbas Rizvi, Medicine, Jinnah Medical and Dental College, Karachi 74800, Sindh, Pakistan
Muhammad Umair, Surgery, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
Agha MW Mirza, Department of Internal Medicine, Jinnah Medical and Dental College, Karachi 74800, Sindh, Pakistan
Author contributions: Kumar A formulating research aims and objectives; Kumar A study design-developing protocols; Kumar A data collection-gathering study measurements and records; Kumar A literature review-scanning relevant literature databases; Kumar A deriving insights from analyzed data; Kumar A writing-review & editing-refining manuscript content for clarity; Kumar C literature review-scanning relevant literature databases; Kumar C methodology-creating analytical procedures; Kumari S writing-original draft-composing manuscript sections; Kumari S preparation-preparing submission‑ready manuscript files; Aneela validation-confirming accuracy of collected data; Aneela quality control-monitoring study qualities using risk of bias assessment tools; Rai R supervision-overseeing research activities and personnel; Rai R project administration-coordinating project tasks and timelines; Kumar K implementing research software tools; Kumar K creating tables; Gyaneshwari implementing research software tools; Gyaneshwari troubleshooting technical research issues; Aslam H literature search-conducting exhaustive database searches; Aslam H organizing and formatting citations; Jawed I writing-original draft-composing initial manuscript sections; Jawed I preparing submission‑ready manuscript files; Alam F final review & approval-reviewing and approving final manuscript version; Rizvi SAFA resource management-allocating research materials and assets; Umair M validation-confirming accuracy of collected data; Umair M quality control-monitoring data consistency and standards; Mirza AMW literature search-conducting exhaustive database searches; Mirza AMW organizing and formatting citations.
Conflict-of-interest statement: There is no conflict of interest among the authors.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Inshal Jawed, Chief Physician, Senior Researcher, Dow Medical College, Dow University of Health Sciences, Baba-e-urdu Karachi, Karachi 75350, Sindh, Pakistan. inshaljwd@gmail.com
Received: January 24, 2025
Revised: March 18, 2025
Accepted: April 25, 2025
Published online: September 20, 2025
Processing time: 200 Days and 19.7 Hours
Abstract
BACKGROUND

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity and mortality, particularly in patients with concomitant renal dysfunction. Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.

AIM

To support clinicians in navigating the complexities of anticoagulation in this high-risk population, ensuring optimal outcomes.

METHODS

The present review followed PRISMA guidelines. Data extraction was conducted using a standardized template that captured key study characteristics: Population demographics, renal function metrics, anticoagulant dosing strategies, and primary and secondary outcomes. For quality assessment, we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials. Observational studies were appraised using the Newcastle-Ottawa Scale.

RESULTS

We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies, balancing thrombotic and bleeding risks. Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease, emphasizing the importance of individualized therapy.

CONCLUSION

The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.

Keywords: Anticoagulation; Atrial fibrillation; Renal dysfunction; Management; Review

Core Tip: Atrial fibrillation (AF) is a common arrhythmia linked to significant morbidity, especially in patients with renal dysfunction. Anticoagulation therapy mitigates thromboembolic risk but poses challenges due to altered drug metabolism and bleeding risks. This systematic review, following PRISMA guidelines, analyzes 16 studies to guide anticoagulant use in this high-risk group. Data extraction covered demographics, renal function, dosing strategies, and outcomes. Quality assessment utilized Cochrane’s Risk of Bias tool and the Newcastle-Ottawa Scale. Evidence favors apixaban for moderate chronic kidney disease and cautious use in end-stage renal disease, stressing individualized treatment. Effective anticoagulation management is crucial for optimizing outcomes in AF patients with renal impairment.