Atrial fibrillation in kidney transplant recipients: is there a place for the novel drugs?

Małyszko, Jolanta; Łopatowska, Paulina; Młodawska, Elżbieta; Musiałowska, Dominika; Małyszko, J.; Tomaszuk‐Kazberuk, Anna

doi:10.1093/ndt/gfx265

Cited by 25 publications

(25 citation statements)

References 65 publications

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“…Although NOACs are nowadays the preferred therapeutic option according to European Society of Cardiology guidelines, patients with markedly reduced renal function, especially with eGFR < 30 ml/min, benefit from VKA treatment [35] . Also patients after kidney transplantation are limited to use of VKA [36,37,38] . From AF -atrial fibrillation Table 3.…”

Section: Discussionmentioning

confidence: 99%

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Tomaszuk‐Kazberuk¹,

Łopatowska²,

Młodawska³

et al. 2019

Heart Beat

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Among patients with AF chronic anticoagulant therapy with vitamin K antagonists (VKA) is suboptimal. Unfortunately, history of thromboembolic events did not cause better international normalized ratio (INR) control. Patients with a history of systemic embolism and very high risk for thromboembolic complications more often had INR below the therapeutic range than the rest of the patients with AF. It can be partly explained by the fact that patients with very high thromboembolic risk at the same time usually have a high risk of bleeding. We may assume that patients with multiple factors associated with inadequate INR may not be ideal candidates for VKA therapy. These patients should be possibly considered for non-vitamin K antagonist oral anticoagulants (NOACs). Further efforts should be made in Poland to improve the quality of antithrombotic care in patients with AF treated with VKA.

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Section: Discussionmentioning

confidence: 99%

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Tomaszuk‐Kazberuk¹,

Łopatowska²,

Młodawska³

et al. 2019

Heart Beat

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“…Although the majority of cases of AF following kidney transplantation developed within the first year after kidney transplantation [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], the true incidence of AF might have been slightly higher. Third, while we demonstrated high mortality and stroke risks in kidney transplant recipients with AF, it remains unclear if anticoagulation use (warfarin and novel agents) in kidney transplant patients would improve patient outcomes; future clinical trials of anticoagulation use in the kidney transplant population with AF are needed [ 27 , 28 , 57 ]. Last, this is a meta-analysis of observational studies, and as such, it could only reveal association, not a causal-effect relationship, between kidney transplantation and AF.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Prognostic Importance of Atrial Fibrillation in Kidney Transplant Recipients: A Meta-Analysis

Chokesuwattanaskul

Khoury

Sharma

et al. 2018

JCM

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This meta-analysis was conducted with the aims to summarize all available evidence on (1) prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following kidney transplantation; (2) the outcomes of kidney transplant recipients with AF; and (3) the trends of estimated incidence of AF following kidney transplantation over time. A literature search was conducted utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through March 2018. We included studies that reported (1) prevalence of pre-existing AF or incidence of AF following kidney transplantation or (2) outcomes of kidney transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018086192). Eight cohort studies with 137,709 kidney transplant recipients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing kidney transplantation was 7.0% (95% CI: 5.6–8.8%) and pooled estimated incidence of AF following kidney transplantation was 4.9% (95% CI: 1.7–13.0%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF (p = 0.93) or post-operative AF after kidney transplantation (p = 0.16). The pooled odds ratios (OR) of mortality among kidney transplant recipients with AF was 1.86 (3 studies; 95% CI: 1.03–3.35). In addition, AF is also associated with death-censored allograft loss (2 studies; OR: 1.55, 95% CI: 1.02–2.35) and stroke (3 studies; OR: 2.54, 95% CI: 1.11–5.78) among kidney transplant recipients. Despite advances in medicine, incidence of AF following kidney transplant does not seem to decrease over time. In addition, there is a significant association of AF with increased mortality, allograft loss, and stroke after kidney transplantation.

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“…But the risk of CVA/TIA is significantly lowered with kidney transplantation (24.6 events per 1,000 patient years) as compared to those on dialysis (45.6 events per 1,000 patient years). 13 Incident AF in patients with CKD is also associated with an increased risk of developing ESRD, stroke, and death. 14,15 In a retrospective analysis of incident CKD patients (n=16,451) from 2000 to 2013, authors reported 612 patients with AF at baseline (prevalent) and 588 patients who developed AF (incident) during the course.…”

Section: Epidemiology Of Af and Cva In Esrdmentioning

confidence: 99%

Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

Goel¹,

Jain²,

Haddad³

et al. 2020

J Stroke

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End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA<sub>2</sub>DS<sub>2</sub>-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

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Atrial fibrillation in kidney transplant recipients: is there a place for the novel drugs?

Cited by 25 publications

References 65 publications

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Epidemiology and Prognostic Importance of Atrial Fibrillation in Kidney Transplant Recipients: A Meta-Analysis

Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

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