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Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis

Toshiki Kuno1, Hisato Takagi2, Tomo Ando3

  • 1Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York.

Journal of the American College of Cardiology
|January 25, 2020
PubMed

Insights

Oral anticoagulants (OACs) did not reduce thromboembolism risk in dialysis patients with atrial fibrillation (AF). Warfarin, dabigatran, and rivaroxaban increased bleeding risk compared to apixaban or no OACs.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Patients undergoing long-term dialysis face elevated bleeding risks.
  • Oral anticoagulants (OACs) are recommended for atrial fibrillation (AF) to prevent stroke, but evidence in dialysis patients is lacking.
  • The net clinical benefit of OACs in this population remains unknown.

Purpose of the Study:

  • To evaluate the efficacy and safety of OACs in patients with AF on long-term dialysis.
  • To compare different OAC strategies regarding thromboembolic events and bleeding risk.

Main Methods:

  • A systematic search of MEDLINE and EMBASE databases was conducted up to June 10, 2019.
  • Included studies investigated OAC efficacy (ischemic stroke/systemic thromboembolism, all-cause mortality) and safety (major bleeding) in AF patients on dialysis.
  • A meta-analysis of 16 observational studies (N=71,877) was performed.

Main Results:

  • OACs, including apixaban and warfarin, did not significantly decrease stroke or systemic thromboembolism risk compared to no anticoagulants.
  • Apixaban 5 mg was associated with significantly lower mortality risk compared to warfarin, apixaban 2.5 mg, or no anticoagulant.
  • Warfarin, dabigatran, and rivaroxaban were linked to a significantly higher risk of major bleeding compared to apixaban or no anticoagulant.

Conclusions:

  • OACs did not demonstrate a reduced risk of thromboembolism in AF patients on long-term dialysis.
  • Certain OACs (warfarin, dabigatran, rivaroxaban) showed increased bleeding risks relative to apixaban and no anticoagulant use.
  • Further randomized clinical trials are needed to validate the benefit-to-risk ratio of OACs in this patient group.
Abstract

Keywords:
anticoagulantatrial fibrillationdialysisnetwork meta-analysis

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