Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation
Abstract Atrial fibrillation (AF) is a frequent comorbid condition in patients with end‐stage renal disease on hemodialysis (HD) with a prevalence of up to 27%. The incidence rate of stroke in AF patients on HD is approximately 5%. The AF‐associated risk of stroke is a major clinical challenge becau...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-10-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | https://doi.org/10.1002/rth2.12250 |
| _version_ | 1797728464015458304 |
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| author | Oliver Königsbrügge Cihan Ay |
| author_facet | Oliver Königsbrügge Cihan Ay |
| author_sort | Oliver Königsbrügge |
| collection | DOAJ |
| description | Abstract Atrial fibrillation (AF) is a frequent comorbid condition in patients with end‐stage renal disease on hemodialysis (HD) with a prevalence of up to 27%. The incidence rate of stroke in AF patients on HD is approximately 5%. The AF‐associated risk of stroke is a major clinical challenge because current evidence for anticoagulation in HD patients with AF is based on observational data. Results from these observational studies is largely contradictory because they do not show a clear benefit of vitamin K antagonists over no treatment in terms of stroke prevention, and they show an increased risk of hemorrhage associated with anticoagulation treatment in HD patients. HD patients were not included in randomized trials of the direct oral anticoagulants (DOACs), and therefore there is no evidence to support efficacy and safety of DOACs compared to vitamin K antagonists in HD patients. The pharmacological characteristics of DOACs are of particular interest in the HD setting. The factor Xa inhibitors rivaroxaban, apixaban, and edoxaban are not predominantly eliminated via the kidneys. The thrombin inhibitor dabigatran is 80% eliminated via the kidneys but is dialyzable due to its low protein binding. In this narrative review, we examine the current state of evidence regarding the prevalence of AF in patients on HD, the associated risk of stroke, and the efficacy and safety of anticoagulation for stroke prevention in the HD setting. Further, based on the pharmacokinetic properties of DOACs, we discuss their potential use in patients on HD and ongoing randomized trials. |
| first_indexed | 2024-03-12T11:14:19Z |
| format | Article |
| id | doaj.art-18230b0db1d84057ad33173dd8f76a52 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T11:14:19Z |
| publishDate | 2019-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-18230b0db1d84057ad33173dd8f76a522023-09-02T02:19:49ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792019-10-013457858810.1002/rth2.12250Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulationOliver Königsbrügge0Cihan Ay1Clinical Division of Hematology and Hemostaseology Department of Medicine I Medical University of Vienna Vienna AustriaClinical Division of Hematology and Hemostaseology Department of Medicine I Medical University of Vienna Vienna AustriaAbstract Atrial fibrillation (AF) is a frequent comorbid condition in patients with end‐stage renal disease on hemodialysis (HD) with a prevalence of up to 27%. The incidence rate of stroke in AF patients on HD is approximately 5%. The AF‐associated risk of stroke is a major clinical challenge because current evidence for anticoagulation in HD patients with AF is based on observational data. Results from these observational studies is largely contradictory because they do not show a clear benefit of vitamin K antagonists over no treatment in terms of stroke prevention, and they show an increased risk of hemorrhage associated with anticoagulation treatment in HD patients. HD patients were not included in randomized trials of the direct oral anticoagulants (DOACs), and therefore there is no evidence to support efficacy and safety of DOACs compared to vitamin K antagonists in HD patients. The pharmacological characteristics of DOACs are of particular interest in the HD setting. The factor Xa inhibitors rivaroxaban, apixaban, and edoxaban are not predominantly eliminated via the kidneys. The thrombin inhibitor dabigatran is 80% eliminated via the kidneys but is dialyzable due to its low protein binding. In this narrative review, we examine the current state of evidence regarding the prevalence of AF in patients on HD, the associated risk of stroke, and the efficacy and safety of anticoagulation for stroke prevention in the HD setting. Further, based on the pharmacokinetic properties of DOACs, we discuss their potential use in patients on HD and ongoing randomized trials.https://doi.org/10.1002/rth2.12250anticoagulationatrial fibrillationbleedingchronic strokefactor Xa inhibitorskidney failure |
| spellingShingle | Oliver Königsbrügge Cihan Ay Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation Research and Practice in Thrombosis and Haemostasis anticoagulation atrial fibrillation bleeding chronic stroke factor Xa inhibitors kidney failure |
| title | Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation |
| title_full | Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation |
| title_fullStr | Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation |
| title_full_unstemmed | Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation |
| title_short | Atrial fibrillation in patients with end‐stage renal disease on hemodialysis: Magnitude of the problem and new approach to oral anticoagulation |
| title_sort | atrial fibrillation in patients with end stage renal disease on hemodialysis magnitude of the problem and new approach to oral anticoagulation |
| topic | anticoagulation atrial fibrillation bleeding chronic stroke factor Xa inhibitors kidney failure |
| url | https://doi.org/10.1002/rth2.12250 |
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