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This systematic review applies PRISMA-guided methods to synthesize evidence on anticoagulant dosing strategies, balancing stroke prevention and safety. Findings support preferential apixaban use in moderate chronic kidney disease and cautious use in end-stage renal disease with individualized 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|\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Exp Med 2025 September 20; 15(3): 105485  \nDOI: 10.5493/wjem.v15.i3.105485 ISSN 2220-315x (online)  \nSYSTEMATIC REVIEWS  \nManagement of anticoagulation in patients with atrial fibrillation and renal dysfunction: A systematic review  \nAnish Kumar, Chander Kumar, Ajay Kumar, Simran Kumari, Aneela, Rahul Rai, Aman Kumar, Kapeel Kumar, Gyaneshwari, Hina Aslam, Inshal Jawed, Farah Alam, Syed Ali Farhan Abbas Rizvi, Muhammad Umair, Agha MW Mirza  \nSpecialty type: Medicine, research and experimental  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade A, Grade B, Grade C  \nNovelty: Grade A, Grade C, Grade C  \nCreativity or Innovation: Grade A, Grade C, Grade D  \nScientific Significance: Grade A, Grade B, Grade C  \nP-Reviewer: Kong YZ; Lulic I  \nReceived: January 24, 2025  \nRevised: March 18, 2025  \nAccepted: April 25, 2025  \nPublished online: September 20, 2025  \nProcessing time: 200 Days and 18.6 Hours  \nAnish Kumar, Chander Kumar, Aneela, Rahul Rai, Aman Kumar, Kapeel Kumar, Gyaneshwari,  \nMedicine, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Sindh, Pakistan  \nAjay Kumar, Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Sindh, Pakistan  \nSimran Kumari, Medicine, Ghulam Muhammad Mahar Medical College, Sukkur 65200, Sindh, Pakistan  \nHina Aslam, Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan  \nInshal Jawed, Dow Medical College, Dow University of Health Sciences, Karachi 75350, Sindh, Pakistan  \nFarah Alam, Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan  \nSyed Ali Farhan Abbas Rizvi, Medicine, Jinnah Medical and Dental College, Karachi 74800, Sindh, Pakistan  \nMuhammad Umair, Surgery, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan  \nAgha MW Mirza, Department of Internal Medicine, Jinnah Medical and Dental College, Karachi 74800, Sindh, Pakistan  \nCorresponding author: Inshal Jawed, Chief Physician, Senior Researcher, Dow Medical College, Dow University of Health Sciences, Baba-e-urdu Karachi, Karachi 75350, Sindh, [Pakistan.](Pakistan. inshaljwd@gmail.com)[ inshaljwd@gmail.com](Pakistan. inshaljwd@gmail.com)  \nAbstract  \nBACKGROUND  \nAtrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity and mortality, particularly in patients with concomitant renal dysfunction. Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.  \n WJEM  [https://www.wjgnet.com](https://www.wjgnet.com) 1 September 20, 2025  Volume 15  Issue 3   \nKumar A et al. Management of anticoagulation with renal comorbidities  \nAIM  \nTo support clinicians in navigating the complexities of anticoagulation in this high-risk population, ensuring optimal outcomes.  \nMETHODS  \nThe present review followed PRISMA guidelines. Data extraction was conducted using a standardized template that captured key study characteristics: Population demographics, renal function metrics, anticoagulant dosing strategies, and primary and secondary outcomes. For quality assessment, we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials. Observational studies were appraised using the Newcastle-Ottawa Scale.  \nRESULTS  \nWe analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies, balancing thrombotic and bleeding risks. Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease, emphasizing the importance of individualized therapy.  \nCONCLUSION  \nThe management","cbCaicfRptbrtXYz","https://ap.wps.com/l/cbCaicfRptbrtXYz","pdf",819673,12,"English","# Abstract\n## Background\n## Aim\n## Methods\n## Results\n## Conclusion\n## Key words\n# Core Tip","[{\"question\":\"What clinical problem does this systematic review address?\",\"answer\":\"The review addresses how to manage anticoagulation in AF patients who also have renal dysfunction, where benefits must be balanced against increased bleeding risk and altered drug handling.\"},{\"question\":\"How were studies identified and analyzed in the review?\",\"answer\":\"The review followed PRISMA guidelines for the systematic review process, using standardized data extraction and applying Cochrane Risk of Bias 2.0 for randomized trials and the Newcastle-Ottawa Scale for observational studies.\"},{\"question\":\"What anticoagulation strategy does the evidence favor?\",\"answer\":\"The evidence supports preferential use of apixaban in moderate chronic kidney disease and cautious use in end-stage renal disease, emphasizing individualized therapy.\"}]","Management of anticoagulation in patients with atrial fibrillation and renal dysfunction - A systematic review | PDF",1790746059]