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Updated: Sep 19, 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

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Optimal Thromboembolism Prevention for Patients With Atrial Fibrillation on Long-Term Dialysis

Kenji Hashimoto1, Tomohiro Fujisaki2,3, Tadao Aikawa4

  • 1Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia.

Pacing and Clinical Electrophysiology : PACE
|June 5, 2025
PubMed

Insights

For atrial fibrillation (AF) patients on dialysis, left atrial appendage occlusion (LAAO) shows promise for preventing thromboembolism. Certain direct oral anticoagulants (DOACs) like rivaroxaban and apixaban also offer favorable safety and efficacy profiles.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Thromboembolism prevention in atrial fibrillation (AF) patients on dialysis is suboptimal.
  • Existing strategies like vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) require further investigation in this population.
  • Left atrial appendage occlusion (LAAO) is an emerging alternative.

Purpose of the Study:

  • To conduct a network meta-analysis comparing the efficacy and safety of thromboembolism prevention strategies in AF patients on dialysis.
  • To identify optimal therapeutic options for this high-risk group.

Main Methods:

  • A comprehensive search of multiple databases was performed up to January 2024.
  • Primary endpoints included thrombotic events (ischemic stroke, systemic thromboembolism) and major bleeding.
  • Strategies were ranked using P-scores.

Main Results:

  • The analysis included 28 studies with 144,630 AF patients on dialysis.
  • DOACs and VKA showed comparable thrombotic event risks to no-anticoagulant therapy.
  • LAAO demonstrated a significantly lower risk of thrombotic events (HR [95% CI]: 0.19 [0.06-0.60]).
  • VKA, regular-dose rivaroxaban, and dabigatran increased major bleeding risk compared to no-anticoagulant.
  • Rivaroxaban 10 mg daily and apixaban 2.5 or 5 mg twice daily did not increase major bleeding risk.
  • LAAO, rivaroxaban 10 mg daily, and apixaban 2.5 or 5 mg twice daily were highly ranked for efficacy and safety.

Conclusions:

  • LAAO may be a suitable therapeutic option for AF patients on dialysis.
  • Low-dose rivaroxaban (10 mg daily) and specific apixaban doses (2.5 or 5 mg twice daily) are also considerable options.
  • Further research is needed to validate these findings.
Abstract

Keywords:
anticoagulantatrial fibrillationdialysisleft atrial appendage occlusion

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