Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse
The most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfa...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
IMR Press
2022-07-01
|
| Series: | Frontiers in Bioscience-Scholar |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/FBS/14/3/10.31083/j.fbs1403021 |
| _version_ | 1811204444289761280 |
|---|---|
| author | Nikolaos Ktenopoulos Marios Sagris Panagiotis Theofilis Sophia Lionaki Loukianos S. Rallidis |
| author_facet | Nikolaos Ktenopoulos Marios Sagris Panagiotis Theofilis Sophia Lionaki Loukianos S. Rallidis |
| author_sort | Nikolaos Ktenopoulos |
| collection | DOAJ |
| description | The most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease (ESKD). On the other hand, direct OACs (DOACs) are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio (INR) monitoring. For those patients, warfarin and apixaban appear to be FDA-approved, whereas dabigatran, rivaroxaban, and edoxaban are not recommended yet. Due to a lack of large randomized studies, data from major trials cannot be extended to dialysis patients. In this review, we summarize the available data and literature referring to patients on chronic hemodialysis with concomitant AF. Due to the scarcity of data, we try to assist clinicians in selecting the appropriate therapy according to the specific characteristics of each patient. Finally, future directions are provided in two key areas of focus: left atrial appendage closure therapies and genetic research. |
| first_indexed | 2024-04-12T03:13:11Z |
| format | Article |
| id | doaj.art-78485e10ee1e4c5c9bb907c560934abc |
| institution | Directory Open Access Journal |
| issn | 1945-0516 |
| language | English |
| last_indexed | 2024-04-12T03:13:11Z |
| publishDate | 2022-07-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Frontiers in Bioscience-Scholar |
| spelling | doaj.art-78485e10ee1e4c5c9bb907c560934abc2022-12-22T03:50:16ZengIMR PressFrontiers in Bioscience-Scholar1945-05162022-07-011432110.31083/j.fbs1403021S1945-0516(22)00057-0Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical ImpasseNikolaos Ktenopoulos0Marios Sagris1Panagiotis Theofilis2Sophia Lionaki3Loukianos S. Rallidis4Internal Medicine Department, Konstantopoulio General Hospital, 14233 Athens, Attica Province, Greece1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Attica Province, Greece1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Attica Province, GreeceNephrology Department & Attikon University Hospital, National & Kapodistrian University of Athens, 12462 Athens, Attica Province, GreeceSecond Department of Cardiology, University General Hospital, “Attikon”, Athens, National and Kapodistrian University of Athens, 11527 Athens, Attica Province, GreeceThe most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease (ESKD). On the other hand, direct OACs (DOACs) are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio (INR) monitoring. For those patients, warfarin and apixaban appear to be FDA-approved, whereas dabigatran, rivaroxaban, and edoxaban are not recommended yet. Due to a lack of large randomized studies, data from major trials cannot be extended to dialysis patients. In this review, we summarize the available data and literature referring to patients on chronic hemodialysis with concomitant AF. Due to the scarcity of data, we try to assist clinicians in selecting the appropriate therapy according to the specific characteristics of each patient. Finally, future directions are provided in two key areas of focus: left atrial appendage closure therapies and genetic research.https://www.imrpress.com/journal/FBS/14/3/10.31083/j.fbs1403021atrial fibrillationchronic kidney diseasehemodialysisdoacsoptimal managementfuture directions |
| spellingShingle | Nikolaos Ktenopoulos Marios Sagris Panagiotis Theofilis Sophia Lionaki Loukianos S. Rallidis Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse Frontiers in Bioscience-Scholar atrial fibrillation chronic kidney disease hemodialysis doacs optimal management future directions |
| title | Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse |
| title_full | Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse |
| title_fullStr | Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse |
| title_full_unstemmed | Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse |
| title_short | Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse |
| title_sort | direct oral anticoagulants in patients on chronic dialysis and concomitant atrial fibrillation a common clinical impasse |
| topic | atrial fibrillation chronic kidney disease hemodialysis doacs optimal management future directions |
| url | https://www.imrpress.com/journal/FBS/14/3/10.31083/j.fbs1403021 |
| work_keys_str_mv | AT nikolaosktenopoulos directoralanticoagulantsinpatientsonchronicdialysisandconcomitantatrialfibrillationacommonclinicalimpasse AT mariossagris directoralanticoagulantsinpatientsonchronicdialysisandconcomitantatrialfibrillationacommonclinicalimpasse AT panagiotistheofilis directoralanticoagulantsinpatientsonchronicdialysisandconcomitantatrialfibrillationacommonclinicalimpasse AT sophialionaki directoralanticoagulantsinpatientsonchronicdialysisandconcomitantatrialfibrillationacommonclinicalimpasse AT loukianossrallidis directoralanticoagulantsinpatientsonchronicdialysisandconcomitantatrialfibrillationacommonclinicalimpasse |