Should Oral Anticoagulation Be Used in ESKD Patients on Hemodialysis with Atrial Fibrillation?: CON

Abstract

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0000022021 and the COMMENTARY: 10.34067/KID.0001372021

Anticoagulant and Antiplatelet Use Among Hemodialysis Patients in the United States Without Medicare

“… 2 Despite clear thrombotic risk in patients with kidney failure, especially those with atrial fibrillation, 1 anticoagulant and antiplatelet use is tempered by limited evidence of efficacy, lack of randomized clinical trials, and concern for serious bleeding in patients with atrial fibrillation undergoing long-term dialysis. 3 , 4 , 5 , 6 Although some studies indicate that anticoagulants reduce stroke, mortality, and thromboembolism without an increase in bleeding, 4 others indicate that anticoagulants do not decrease mortality rates or risk of stroke in these patients and may increase bleeding. 5 This opposing evidence may be due to anticoagulant dosage, patient bias, stage of kidney disease, and study methodology.…”

“… 3 , 4 , 5 , 6 Although some studies indicate that anticoagulants reduce stroke, mortality, and thromboembolism without an increase in bleeding, 4 others indicate that anticoagulants do not decrease mortality rates or risk of stroke in these patients and may increase bleeding. 5 This opposing evidence may be due to anticoagulant dosage, patient bias, stage of kidney disease, and study methodology. 4 , 5 , 6 Faced with contradictory findings, the current cardiovascular treatment guidelines provide vague recommendations on anticoagulant and antiplatelet use in patients with kidney failure.…”

“… 5 This opposing evidence may be due to anticoagulant dosage, patient bias, stage of kidney disease, and study methodology. 4 , 5 , 6 Faced with contradictory findings, the current cardiovascular treatment guidelines provide vague recommendations on anticoagulant and antiplatelet use in patients with kidney failure. 7…”