American Society of Hirudotherapy

Renal Function Considerations for Stroke Prevention in Atrial Fibrillation.

Research article published in The American journal of medicine (2017)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical TrialsFanikos et al. · The American journal of medicine, 2017

Abstract

Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants (DOACs) have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, DOACs were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in nonvalvular atrial fibrillation patients with mild or moderate renal impairment. Renal function decrease appears less impacted by DOACs, which are associated with a better risk-benefit profile than warfarin in patients with decreasing renal function over time. Limited data address the risk-benefit profile of DOACs in patients with severe impairment or on dialysis.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReviewResearch Support, Non-U.S. Gov't
Indexed MeSH termsAdministration, OralAnticoagulantsAntithrombinsAtrial FibrillationDabigatranEmbolismFactor Xa InhibitorsHemorrhageHumansPharmaceutical ResearchPyrazolesPyridines

Summary

Renal Function Considerations for Stroke Prevention in Atrial Fibrillation.

Why This Matters for Hirudotherapy

This review surveys how renal function shapes the choice and dosing of direct oral anticoagulants (DOACs) for stroke prevention in nonvalvular atrial fibrillation, noting that in randomized trials DOACs were at least as effective as warfarin with less bleeding, and offered a better risk-benefit profile than warfarin as renal function declined; it also flags that data are limited in severe impairment or dialysis. For ASH, it usefully frames the broader anticoagulation landscape against which medicinal-leech therapy is sometimes positioned: systemic anticoagulants carry organ-dependent dosing and bleeding trade-offs that local, transient leech salivary anticoagulation does not directly replicate. As a narrative review summarizing other trials rather than reporting new data, it provides context only and makes no statement about hirudotherapy or leech-derived agents.

Citation

Renal Function Considerations for Stroke Prevention in Atrial Fibrillation.

Fanikos et al. · The American journal of medicine, 2017

DOI

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

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