Vnitr Lek 2025, 71(7):425-430 | DOI: 10.36290/vnl.2025.078

Indications, efficacy, and safety of NOACs in patients with CKD

Marie Vanková¹, Kateřina Oulehle¹, Oskar Zakiyanov², Jan Vachek^{1, 2}, Vladimír Tesař²

¹ Interní oddělení s hemodialyzačním střediskem, Klatovská nemocnice, a. s.

² Klinika nefrologie 1. LF UK a VFN v Praze

Chronic kidney disease (CKD) represents a significant and independent risk factor for cardiovascular morbidity and mortality. Patients with CKD frequently present with atrial fibrillation and venous thromboembolism, creating a clinical need for optimal anticoagulation strategies that balance efficacy and safety. However, the selection of an appropriate anticoagulant in this population is challenging, owing both to the increased risk of bleeding complications and to the altered pharmacokinetics of renally excreted agents. Over the past decade, non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as a widely adopted alternative to warfarin and have progressively become the preferred option for most patients with atrial fibrillation and venous thromboembolism. Their use among patients with CKD is also increasing, yet it requires an individualized approach that carefully considers the degree of renal impairment. The objective of this review is to summarize current indications, efficacy, and safety data for NOACs in patients with CKD, to synthesize the available clinical evidence, and to provide practical recommendations for their use in routine internal medicine practice.

Keywords: atrial fibrillation, chronic kidney disease, anticoagulation therapy, warfarin, NOAC, DOAC, dabigatran, rivaroxaban, apixaban, edoxaban, efficacy, safety, bleeding complications, stroke prevention.

Accepted: October 16, 2025; Published: October 31, 2025  Show citation