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Anticoagulation in CKD AF — ESENeph MCQ

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ModerateChronic Kidney DiseaseAnticoagulation in CKD AFESENeph

A 55-year-old man with CKD G3b (eGFR 38 mL/min/1.73m2) and atrial fibrillation needs anticoagulation. His CHA2DS2-VASc score is 4. Which anticoagulant approach is recommended?

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Correct answer: C — DOAC at appropriate renal-adjusted dose

NICE and ESC guidelines recommend DOACs over Warfarin for atrial fibrillation in most patients, including those with moderate CKD (G3a-G3b). At eGFR 30-50, dose adjustments apply for some DOACs (Apixaban 5 mg BD standard; Rivaroxaban 15 mg OD at eGFR 15-50; Edoxaban 30 mg at eGFR 15-50). DOACs are preferred over Warfarin in CKD due to more predictable pharmacokinetics and lower bleeding risk. Warfarin accelerates vascular calcification and may worsen calciphylaxis risk in CKD.

Reference: NICE NG196 2021 – AF; ESC 2020 – AF Guidelines