Keywords
Chronic kidney disease
Anticoagulation
Direct oral anticoagulants
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Abstract
Objective: To analyze the scientific evidence regarding the efficacy and safety of anticoagulants in patients with non-valvular atrial fibrillation associated with advanced chronic kidney disease (G4 e G5). Methods: Integrative literature review conducted in the PubMed and LILACS databases, including studies published in the last five years in Portuguese, English, and Spanish. The PICO strategy was used to formulate the guiding question. Clinical trials, observational studies, and systematic reviews assessing efficacy and safety outcomes of anticoagulation in this population were selected. Results: Seven studies comprised the final sample. Overall, direct oral anticoagulants (DOACs), particularly apixaban and rivaroxaban, showed a lower risk of major bleeding compared to vitamin K antagonists, without a significant increase in thromboembolic events. Methodological heterogeneity among the studies was noted. Final Considerations: DOACs demonstrate a more favorable safety profile compared to vitamin K antagonists in patients with atrial fibrillation and advanced chronic kidney disease, representing a promising therapeutic alternative. However, clinical decisions should be individualized, and larger randomized trials are needed to consolidate the evidence.
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