Key result
In patients with end-stage renal disease, the efficacy of anticoagulant and antiplatelet agents remains unclear, as warfarin does not appear to decrease stroke risk but increases bleeding risk.
Why the study?
What are the risks and benefits of anticoagulant and antiplatelet medications in patients with end-stage renal disease?
What are the risks and benefits of anticoagulant and antiplatelet medications in patients with end-stage renal disease?
The efficacy and safety of anticoagulants and antiplatelets in ESRD remain unclear, with warfarin showing increased bleeding risks without clear stroke prevention benefits in atrial fibrillation.
Antithrombotic decisions in ESRD warrant individualized caution; leaves open need for RCTs to define net benefit.
PURPOSE OF REVIEW: Atrial fibrillation and cardiovascular death are increased in end-stage renal disease (ESRD) patients compared to the general population. The effect of anticoagulant and antiplatelet medications for these indications in ESRD is unclear. However, both classes of medications have been used for the preservation of vascular access. This review explores the risks and benefits of anticoagulant and antiplatelet medications in ESRD. RECENT FINDINGS: ESRD patients with atrial fibrillation have a two and three-fold greater risk of death and stroke, respectively, than ESRD patients without atrial fibrillation. Warfarin does not appear to decrease this risk, and increases the risk of bleeding and vascular calcification. Warfarin also does not appear to be effective for vascular access preservation. In a few large observational studies, antiplatelet agents did not decrease the risk of cardiovascular death, but confounding by indication is likely. Antiplatelet agents do appear to prolong unassisted arteriovenous graft patency, but the effect is modest. SUMMARY: The role of anticoagulant and antiplatelet agents for atrial fibrillation and cardiovascular disease in ESRD remains unclear. Well designed randomized controlled trials to determine the role of anticoagulation in ESRD patients with atrial fibrillation, and anticoagulant and antiplatelet medications in the preservation of central venous catheter function are required.
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Harmon et al. (2013) conducted a review in End-stage renal disease (ESRD). Anticoagulant and antiplatelet medications was evaluated. In patients with end-stage renal disease, the efficacy of anticoagulant and antiplatelet agents remains unclear, as warfarin does not appear to decrease stroke risk but increases bleeding risk.
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