Anticoagulation in Patients with End-Stage Renal Disease and Non-Valvular Atrial Fibrillation – Review Article

Abstract

Over the years, the number of patients with end-stage renal disease (ESRD) have been steadily increasing. Cardiovascular causes account for 55.2% of all deaths among ESRD patients. In particular, there is an increased risk of atrial fibrillation (AF) & venous thromboembolism (VTE). AF is more prevalent in hemodialysis (HD) (21.3%) than in peritoneal dialysis (PD) (15.5%) or in patients with kidney transplant (13.7%). In addition to AF, the risk of stroke (event rate of 5.61 per 100 person years) in ESRD patients is greatly increased compared to those without renal impairment (event rate of 3.61 per 100 person years), which is very concerning due to the already increased cardiovascular mortality among these patients. ESRD is a complex condition in which usual interventions do not often provide the desired outcome seen in other comorbidities. The inherent paradox of hypercoagulability and increased risk of bleeding along with the lack of risk tratification models further complicate the selection of anticoagulants in patients with ESRD and AF. Due to the lack of controlled trials and the contradictory results and outcomes, it is not possible to argue for or against the use of any particular therapeutic agent. Data regarding risks and benefits of antiplatelet agents use among ESRD patients with AF has been conflicting and there is no consensus or guideline regarding their routine use.

Keywords

• end stage renal disease
• esrd
• atrial fibrillation
• anticoagulation
• non valvular
• dialysis
• novel oral anticoagulants
• noacs
• direct oral anticoagulants
• doacs
• coumadin
• warfarin
• vitamin k antagonist