Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Con

Abstract

Among patients with atrial fibrillation, prophylaxis for stroke prevention with the use of anticoagulation is well established in the general population. A number of randomized controlled trials and evidence-based risk prediction tools clearly delineate the benefit and risks of therapy. Despite the high incidence of atrial fibrillation in the late stage CKD and ESRD populations, little high quality evidence exists in these populations. Is it appropriate then to extrapolate findings from the general population to those with CKD/ESRD? In our view, too much uncertainty exists regarding proof of efficacy with clear signals of harm. Routine anticoagulation for stroke prevention in atrial fibrillation is not recommended for the majority of CKD and ESRD patients.

Direct Oral Anticoagulants in End-Stage Renal Disease

“…The effectiveness and safety of VKA among patients with ESRD and AF is highly debated, 21,22 as reflected in the wide variability of VKA use among patients with ESRD in different high-income countries. 23 Similarly, studies from the United States preceding market availability of the direct oral anticoagulants (DOACs) report a 15.5 to 62.3% prevalence of VKA use in patients on dialysis with incident AF.…”

Nonvalvular Atrial Fibrillation and Diabetic Nephropathy: Epidemiology, Prognosis, and Choice of Anticoagulant Therapy

“…Одним из дискуссионных вопросов остается выбор антикоагулянтной терапии у больных с ФП и терминальной стадии ХБП, а также находящихся на диализной терапии и перенесших трансплантацию почки [96][97][98][99]. В настоящее время результаты РКИ по оценке эффективности и безопасности НПОАК у больных, находящих-КЛИНИЧЕСКИЕ СЕМИНАРЫ § ся на диализной терапии, и у пациентов c тяжелой ХБП при клиренсе креатинина менее 30 мл / мин отсутствуют.…”

“…Международное научное сообщество разделилось на противников и сторонников назначения пероральных антикоагулянтов больным с ФП и терминальной стадией ХБП [96,97]. Единое мнение обеих стороннеобходимы РКИ.…”

Use of Oral Anticoagulation for Patients with ESRD on Hemodialysis with Atrial Fibrillation: Verdict 1

“…Review of the observational literature presented by both McCullough et al (1) and Keskar et al (2) suggests that risks of warfarin may outweigh the benefits. As both sides point out, the risks of warfarin are significant and include major hemorrhage from out of range International Normalized Ratio values, possibly from vitamin K deficiency from malnutrition, frequent antibiotic exposure, and chronic illness seen in patients with ESRD (10).…”