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Review
. 2016 Nov 7;11(11):2085-2092.
doi: 10.2215/CJN.03200316. Epub 2016 Oct 25.

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

Vaibhav Keskar  1 , Manish M Sood  2
Affiliations
Review

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

Vaibhav Keskar et al. Clin J Am Soc Nephrol. .

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.

Keywords: Anticoagulation; Blood Coagulation; Chronic; Humans; Incidence; Kidney Failure; Renal Insufficiency; Risk; Uncertainty; atrial fibrillation; chronic kidney disease; hemorrhage; stroke; warfarin.

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Figures

Figure 1.
Figure 1.
Receiver operating characteristic curves of CHADS2 and CHA2DS2-VASc scores in predicting ischemic stroke in patients with ESRD. (Modified from Chao et al. reference , with permission). CHADS2, congestive heart failure, hypertension, anemia, diabetes mellitus and stroke.
See this image and copyright information in PMC

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