Oral anticoagulation in end-stage renal disease and atrial fibrillation: is it time to just say no to drugs?

Atrial fibrillation (AF) frequently complicates the management of chronic kidney disease, especially in patients with end-stage renal disease (ESRD). AF occurs in approximately one in five of the 650 000 patients with ESRD in the USA.1 ESRD confers increased risk for AF, while AF hastens progression to ESRD. The presence of chronic kidney disease in patients with AF is associated with an increased risk for ischaemic stroke independent of traditional risk factors. In addition, chronic kidney disease and particularly ESRD are associated with an increased risk of bleeding. Little is understood about how to safely reduce the risk of thromboembolic events in patients with AF and ESRD. Prospective trials of AF have uniformly excluded patients with a glomerular filtration rate (GFR) <30 mL/hour. ESRD produces alterations in haemostasis that predispose patients to haemorrhagic (platelet α granule depletion, reduced endothelial cell adhesion molecule expression) and thrombotic (increased circulating fibrinogen) complications,...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research