Key result
Current observational evidence for anticoagulation in end-stage kidney disease patients with atrial fibrillation suggests a lack of benefit in stroke risk reduction and an increase in bleeding risk.
Why the study?
Does anticoagulation reduce stroke risk without excessive bleeding in patients with atrial fibrillation and end-stage kidney disease?
Does anticoagulation reduce stroke risk without excessive bleeding in patients with atrial fibrillation and end-stage kidney disease?
Observational data suggest that anticoagulation for atrial fibrillation in end-stage kidney disease may not reduce stroke risk but increases bleeding risk, highlighting the urgent need for randomized controlled trials.
Atrial fibrillation (AF) is the most common arrhythmia in the general population and it has been found to have a higher prevalence in end-stage kidney disease (ESKD). It is associated with a higher risk of stroke and mortality compared to those without AF. Patients with ESKD have generally been excluded from randomized controlled trials (RCTs) evaluating the efficacy of anticoagulation in reduction of stroke risk. Current observational evidence for anticoagulation for AF in the ESKD population has yielded conflicting results, but in aggregate favours a lack of benefit in stroke risk reduction with an increase in bleeding risk. There are also reports that warfarin use in ESKD patients on dialysis is associated with greater International Normalised Ratio (INR) variability and increased risk of vascular calcification and calciphylaxis (uraemic calcific arteriolopathy). RCTs are required to assess the net clinical benefit of anticoagulation in this group.
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Lee et al. (2015) conducted a review in Atrial fibrillation in end-stage kidney disease. Anticoagulation (primarily warfarin) vs. No anticoagulation was evaluated. Current observational evidence for anticoagulation in end-stage kidney disease patients with atrial fibrillation suggests a lack of benefit in stroke risk reduction and an increase in bleeding risk.
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