Key result
Oral anticoagulants increase bleeding risk in patients with end-stage renal disease and hemodialysis up to 10-fold compared with non-chronic kidney disease patients on warfarin.
Why the study?
Randomized controlled trials of oral anticoagulants in atrial fibrillation excluded patients with end-stage renal disease, leaving conflicting data and recommendations in this population.
This review highlights the complex balance of stroke and bleeding risks in patients with atrial fibrillation and end-stage renal disease, proposing a modified strategy for oral anticoagulant use.
Heightens caution for oral anticoagulants in ESRD on hemodialysis; leaves open optimal strategies pending randomized trials.
The role of oral anticoagulants (OAC) in atrial fibrillation (AF) is well established. However, none of the randomized controlled trials included patients with end-stage renal disease (ESRD) leaving a lack of evidence in this large, challenging and unique patient group. Patients on hemodialysis (HD) with AF have additional risk factors for stroke due to vascular comorbidities, HD treatment, age, and diabetes. Conversely, they are also at increased risk of major bleeding due to uremic platelet impairment. Anticoagulants increase bleeding risk in patients with ESRD and HD up to 10-fold compared with non chronic kidney disease (CKD) patients on warfarin. There are conflicting data and recommendations regarding use of OACs in ESRD which will be reviewed in this article. We conclude by proposing a modified strategy for OAC use in ESRD based on the latest evidence.
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Zaman et al. (2019) conducted a review in Atrial fibrillation and end-stage renal disease. Oral anticoagulants vs. Non-chronic kidney disease patients on warfarin was evaluated. Oral anticoagulants increase bleeding risk in patients with end-stage renal disease and hemodialysis up to 10-fold compared with non-chronic kidney disease patients on warfarin.
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