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Updated: Dec 11, 2025

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

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[Dilemma situation: Oral anticoagulation in dialysis patients with non-valvular atrial fibrillation]

Vincent Brandenburg, Gunnar H Heine

    Deutsche Medizinische Wochenschrift (1946)
    |August 25, 2020
    PubMed

    Insights

    For non-valvular atrial fibrillation (nvAF) patients with severe CKD, non-vitamin K oral anticoagulants (NOACs) are preferred over vitamin K antagonists. Evidence is limited, but NOACs or left atrial appendage occlusion may be best for preventing thromboembolic events.

    Area of Science:

    • Cardiology
    • Nephrology
    • Pharmacology

    Background:

    • Non-vitamin K dependent oral anticoagulants (NOACs) are recommended for preventing thromboembolic events in non-valvular atrial fibrillation (nvAF) patients with normal kidney function or mild-to-moderate chronic kidney disease (CKD).
    • Limited evidence exists regarding the risk-benefit of oral anticoagulation (OAC) in nvAF patients with severe CKD, especially those on dialysis.

    Purpose of the Study:

    • To evaluate the efficacy and safety of OAC strategies in nvAF patients with severe CKD.
    • To compare NOACs with vitamin K antagonists (VKAs) in this high-risk population.
    • To provide guidance on anticoagulation for dialysis patients with nvAF.

    Main Methods:

    • The study reviews existing evidence and expert opinion due to the lack of large randomized controlled trials.
    • Focuses on the risk of thromboembolic events versus bleeding risk in severe CKD patients.

    Main Results:

    • No large randomized studies specifically assess OAC in nvAF patients with severe CKD or on dialysis.
    • Current evidence suggests NOACs or left atrial appendage occlusion may be preferable to VKAs in dialysis patients with nvAF when anticoagulation is deemed necessary.
    • OAC use in this population is often off-label in Europe.

    Conclusions:

    • In dialysis patients with nvAF requiring anticoagulation, NOACs or left atrial appendage occlusion are suggested over VKAs due to limited evidence and potential risks.
    • Further research is needed to establish optimal anticoagulation strategies for nvAF patients with severe CKD.

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