Therapeutic opportunities of apixaban in patients with atrial fibrillation and reducing the risk of cerebrovascular complications in chronic kidney disease

The review article is devoted to the possibilities of using the oral anticoagulant apixaban in patients with atrial fibrillation (AF) and to reduce the risk of cerebral complications in chronic kidney disease (CKD). The generality of risk factors and mechanisms of the occurrence of AF in patients with CKD are considered. The therapeutic possibilities have been demonstrated for the use of oral anticoagulants, in particular apixaban, in AF in the CKD association. The main mechanisms of kidney damage during therapy with vitamin K antagonists are shown. Apixaban is shown to be more effective than warfarin to prevent stroke regardless of the severity of renal dysfunction, and in patients with creatinine clearance less than 50 ml/min, the benefits of apixaban in reducing the frequency of major bleeding are most pronounced degrees. In AF patients with CKD C1-C4 gradations, dose adjustment of apixaban is not required. The safety of the use of apixaban in a full dose (5 mg 2 times a day) in patients with terminal CKD has been approved, subject to regular hemodialysis.