Anticoagulation Status in Maintenance Dialyzed Patients with Nonvalvular Atrial Fibrillation - Single Polish Center Report
Author(s): Zaneta Jankowska, Marta Zaborowska, Katarzyna Klejna, Beata Naumnik
Background: Atrial fibrillation is the most common cardiac arrhythmia among patients with chronic kidney disease. Patients with both, atrial fibrillation and renal failure, have a significantly higher risk of thromboembolism and bleeding at the same time. Our aim was to determine whether end-stage renal disease-atrial fibrillation patients were treated with oral anticoagulants according to the current recommendations.
Methods and Results: This is a retrospective non-randomized study based on data from the 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, comprising of 148 patients with end-stage renal disease (105 patients on hemodialysis, 43 patients on peritoneal dialysis), of whom 29 (24 on hemodialysis and 5 on peritoneal dialysis) had a diagnosis of nonvalvular atrial fibrillation. Currently, only 2 patients (6.9% of all study group) on peritoneal dialysis were treated with anticoagulants from Vitamin K antagonists group and 1 of them had double therapy-oral anticoagulant plus antiplatelet drug. Direct oral anticoagulants were not used by any patient. Vitamin K antagonists were withdrawn in 10 individuals. Bleeding was the main reason of resigning from anticoagulants during treatment.
Conclusions: Not only did all the dialyzed patients fulfill the criteria to introduce oral anticoagulation (according to the CHA2DS2-VASc scale) in the observed cohort, but also they had a high risk of bleeding in HAS-BLED score. There is no data to confirm safety and effectiveness of oral anticoagulants in European population treated with dialysis so far. The warfarin therapy involves increased risk of mortality, stroke, major bleeding and calciphylaxis among patients with end stage renal disease. The benefits from using direct oral anticoagulants remain unproven, so left atrial appendage occlusion may be the best alternative to oral anticoagulation in the above group.