Document Detail

Anticoagulation for atrial fibrillation in patients on dialysis: are the benefits worth the risks?
MedLine Citation:
PMID:  23079746     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Atrial fibrillation is common among patients with end-stage renal disease undergoing hemodialysis. Although oral anticoagulation is recommended for stroke prevention in most patients with atrial fibrillation, limited evidence is available to guide treatment in hemodialysis patients with this arrhythmia. We summarize the available evidence on the epidemiology of atrial fibrillation in dialysis patients and review the data on the effectiveness of oral anticoagulation in this population.
RECENT FINDINGS: Atrial fibrillation is increasingly common in patients undergoing chronic hemodialysis, especially among older patients wherein one in six patients is diagnosed with this arrhythmia. Patients with atrial fibrillation experience double the mortality of otherwise similar patients without it. Few hemodialysis patients with atrial fibrillation receive oral anticoagulation, which is consistently associated with excess risks of hemorrhagic stroke. Observational studies did not detect a beneficial association of oral anticoagulation with the risk of ischemic stroke, with some studies describing higher risks of ischemic stroke among warfarin users. New therapeutic options including one oral direct thrombin inhibitor and two oral factor Xa inhibitors have become available, but were not tested in patients with advanced kidney disease.
SUMMARY: Atrial fibrillation is increasingly common in patients undergoing hemodialysis, yet little is known about the optimal management of these patients. The current evidence does not support net benefits from oral anticoagulation in the dialysis population.
Jenny I Shen; Mintu P Turakhia; Wolfgang C Winkelmayer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  21     ISSN:  1473-6543     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-19     Completed Date:  2013-03-29     Revised Date:  2014-06-20    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  600-6     Citation Subset:  IM    
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage,  adverse effects,  therapeutic use*
Atrial Fibrillation / drug therapy*,  epidemiology
Intracranial Hemorrhages / chemically induced
Kidney Failure, Chronic / epidemiology,  therapy*
Physician's Practice Patterns
Renal Dialysis* / adverse effects
Risk Assessment
Risk Factors
Stroke / epidemiology,  prevention & control*
Treatment Outcome
Grant Support
Reg. No./Substance:

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