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Review
. 2018 Nov;38(6):618-628.
doi: 10.1016/j.semnephrol.2018.08.006.

Oral Anticoagulation in Patients With End-Stage Kidney Disease on Dialysis and Atrial Fibrillation

Austin Hu  1 , Jingbo Niu  1 , Wolfgang C Winkelmayer  2
Affiliations
Review

Oral Anticoagulation in Patients With End-Stage Kidney Disease on Dialysis and Atrial Fibrillation

Austin Hu et al. Semin Nephrol. 2018 Nov.

Abstract

Patients with end-stage kidney disease (ESKD) have an elevated incidence of atrial fibrillation (AF) and are at increased risk for thromboembolic events. However, these patients are also at increased risk for bleeding and it is unclear whether they benefit from an oral anticoagulant. Point prevalent on July 1, 2015, only ~28% of dialysis patients with AF were on oral anticoagulation. Warfarin was the most commonly used oral anticoagulant, followed by apixaban, while dabigatran and rivaroxaban were rarely used. This article reviews the current evidence regarding each oral anticoagulant especially as they relate to patients with ESKD.

Keywords: Hemodialysis; arrhythmia; drug safety; outcomes; peritoneal dialysis.

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Figures

Figure 1:
Figure 1:. The inter-relationship between chronic kidney disease and atrial fibrillation risk factors.
Note: This figure depicts the inter-relationship between CKD and AF. Both diseases share multiple risk factors, disease states, and pathological processes that can predispose or cause both CKD and AF. Patients with CKD also tend to be more exposed to the health care system, which increases the chances of diagnosing paroxysmal AF and vice-versa.
Figure 2:
Figure 2:. Period prevalence of any oral anticoagulant, or specific agents, between July and December 2015, among patients with ESKD on dialysis, by dialysis modality.
HD – hemodialysis; PD – peritoneal dialysis
Figure 3:
Figure 3:. Patterns of new initiation of individual oral anticoagulants in patients with ESKD on dialysis, July to December 2015.
Note: All point prevalent patients on dialysis on July 1 2015 in the USRDS previously diagnosed with atrial fibrillation. Anticoagulation use was assessed between July and December 2015, with new use ascertained by absence of a filled prescription for the same anticoagulant in the previous 6 month period. All patients had Medicare A, B, and D coverage.
See this image and copyright information in PMC

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017;135:e146–e603. - PMC - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014;129:837–47. - PMC - PubMed
    1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:e1–76. - PubMed
    1. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857–67. - PubMed
    1. Hogg K, Weitz JI. Blood Coagulation and Anticoagulant, Fibrinolytic, and Antiplatelet Drugs In: Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 13e . New York, NY: McGraw-Hill Education; 2017.

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