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Patients with A-Fib and Kidney Disease: Should You be on Blood Thinners?

If you have Atrial Fibrillation and also suffer from Chronic Kidney Disease (CKG), beware! Being on an anticoagulant may make you more prone to stroke. That’s according to UK researchers.

In a newly published retrospective study from England (The United Kingdom), 7,000 patients over age 65 with chronic kidney disease who later developed A-Fib had more strokes (and hemorrhage bleeding) than those not taking anticoagulants.

Anticoagulant may make you more prone to stroke.

In fact, patients taking anticoagulants were 2.6 times as likely to have a stroke (and 2.4 times as likely to have major hemorrhagic bleeding).

Reduced Kidney Function and Atrial Fibrillation

Reduced kidney function or chronic kidney disease is very common in older people. Chronic kidney disease (CKD) and Atrial Fibrillation (A-Fib) often co-exist. A-Fib can promote or accelerate the progression of chronic kidney disease.

Worldwide, it’s estimated that 15–20% of patients with chronic kidney disease (CKD) also have Atrial Fibrillation.

Research Conclusion

According to the study’s first author, Dr. Shankar Kumar of the UCL Center for Medical Imaging, London:

“As we found in this particular group, their medication (anticoagulant) seems to do the opposite of its intended effect.

…Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation.”

A-Fib and Anticoagulation: First Check for Reduced Kidney Function 

How to measure if your kidneys are working? A Glomerular Filtration Rate [GFR) of 60 or higher is normal, while a GFR below 60 may mean kidney disease.
This study only dealt with Chronic Kidney Disease (CKD). But common sense dictates that the findings of this study may also affect anyone with reduced kidney function.

In the early stages of Chronic Kidney Disease, there may be few signs or symptoms. CKD may not become apparent until kidney function is significantly impaired.

From this study, we can say it’s imperative that anyone with A-Fib especially older people, should be checked for reduced or chronic kidney disease before being put on anticoagulants.

Alternatives to Anticoagulants

This study points out the difficulty for A-Fib patients taking anticoagulants who also have chronic kidney disease: The anticoagulants meant to prevent stroke actually increase stroke risk and hemorrhage bleeding.

If you’re in this situation, you may want to consider these two options:

1. Closure of the Left Atrial Appendage (where most A-Fib clots originate). An occlusion device like a Watchman may be an alternative to anticoagulants. (For more, see my article, The Watchman™ Device: An Alternative to Blood Thinners);

2. Free yourself from A-Fib. Consider a catheter ablation procedure (or mini-maze surgery). Reasoning: if you no longer have A-Fib, you can’t have an ‘A-Fib-related’ stroke.

But know that even without A-Fib, you can still have a stroke from other causes. (Right now, we don’t have a therapy that will absolutely guarantee you will never have a stroke.)

What This Means for A-Fib Patients

For A-Fib patients who also have chronic kidney disease, being on an anticoagulant may make you more prone to stroke, not less.

Accordingly, if you have A-Fib and are taking anticoagulants, ask your doctor if you have been checked for ‘reduced kidney function’.

And if in the future, you develop reduced kidney function, discuss these research findings with your doctors (print a copy of this post and include the ‘References for this Article’ below).

Paradox: If you have kidney disease, the anticoagulants meant to prevent stroke actually increase stroke risk and hemorrhage bleeding.

Resources for this Article
• Boseley, S. Blood-thinning drugs designed to cut stroke risk may actually increase it. The Guardian. February 15, 2018.

• Kumar, S. et al. Ischemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. BMJ 2018;360. doi:

• McManus, DD, et al. The Relationship Between Atrial Fibrillation and Chronic Kidney Disease: Epidemiologic and Pathophysiologic Considerations for a Dual Epidemic. J Atr Fibrillation. 2012 Jun-Jul; 5(1): 442. doi: 10.4022/jafib.442

• Kirchhof, P., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Chronic kidney disease. Europace Advance Access. August 27, 2016 doi:10.1093/europace/euw295.

• Hart RG, et al. Stroke prevention in atrial fibrillation patients with chronic kidney disease. Can J Cardiol 2013;29: S71–78.

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