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Vitamin K antagonists for stroke prevention in hemodialysis patients with atrial fibrillation: a systematic review and meta-analysis
Conclusion Our meta-analysis revealed a trend for a reduction of the risk of ischemic stroke in hemodialysis patients with AF treated with VKA. The true protective effect may have been underestimated, owing to inclusion of low-risk patients not expected to benefit from anticoagulation and to suboptimal anticoagulation. However, assessment of the overall effect of VKA in hemodialysis patients should also take into account the increased risk of bleeding, in particular of hemorrhagic stroke. Whether new oral anticoagulants provide a better benefit–risk ratio in hemodialysis patients should be the subject of future trials.
Source: American Heart Journal - October 4, 2016 Category: Cardiology Source Type: research

Direct oral anticoagulants in chronic kidney disease: an update
Purpose of review Direct oral anticoagulants (DOACs) are variably eliminated by the kidneys rendering their use potentially problematic in patients with chronic kidney disease (CKD) or necessitating appropriate dose adjustment. Recent findings Both observational and limited randomized trial data for DOACs compared with no treatment or with warfarin for patients with atrial fibrillation on maintenance dialysis were recently published. In a randomized trial in patients on hemodialysis, there was no significant difference in vascular calcification between patients who received rivaroxaban with or without vitamin K2 or vi...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Cardiovascular and renal outcomes in patients with atrial fibrillation and stage 4 –5 chronic kidney disease receiving direct oral anticoagulants: a multicenter retrospective cohort study
AbstractThe role of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and stage 4 –5 chronic kidney disease (CKD) is controversial. Electronic medical records from 2012 to 2021 were retrieved for patients with AF and stage 4–5 CKD receiving oral anticoagulants. Patients were separated into those receiving DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) or vitamin K ant agonists (VKA). Primary outcomes included ischemic stroke (IS), systemic thrombosis (SE), major bleeding, gastrointestinal bleeding, hemorrhagic stroke, acute myocardial infarction, cardiovascular death, and all-cause dea...
Source: Journal of Thrombosis and Thrombolysis - August 21, 2023 Category: Hematology Source Type: research

Anticoagulation in Patients with Advanced Chronic Kidney Disease: Walking the Fine Line between Benefit and Harm
Publication date: Available online 11 July 2019Source: Canadian Journal of CardiologyAuthor(s): Januvi Jegatheswaran, Gregory L. Hundemer, David Massicotte-Azarniouch, Manish M. SoodAbstractChronic kidney disease affects over 3 million Canadians and is highly associated with cardiovascular diseases that require anticoagulation, such as atrial fibrillation and venous thromboembolism. Patients with chronic kidney disease are at a problematic crossroads; they are at high risk of both thrombotic conditions requiring anticoagulation and bleeding complications due to anticoagulation. The limited high-quality clinical evidence to...
Source: Canadian Journal of Cardiology - July 12, 2019 Category: Cardiology Source Type: research

Benefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease: A Systematic Review and Meta-analysis.
Conclusion: In early-stage CKD, NOACs had a benefit-risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs. Primary Funding Source: None. (PROSPERO: CRD42017079709). PMID: 31307056 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - July 15, 2019 Category: Internal Medicine Authors: Ha JT, Neuen BL, Cheng LP, Jun M, Toyama T, Gallagher MP, Jardine MJ, Sood MM, Garg AX, Palmer SC, Mark PB, Wheeler DC, Jha V, Freedman B, Johnson DW, Perkovic V, Badve SV Tags: Ann Intern Med Source Type: research

Oral Anticoagulation in Chronic Kidney Disease and Atrial Fibrillation.
CONCLUSION: The cardiological societies' recommendation that patients with atrial fibrillation should be given oral anticoagulant drugs applies to the majority of such patients who also have chronic kidney disease. PMID: 29789105 [PubMed - in process]
Source: Deutsches Arzteblatt International - May 24, 2018 Category: General Medicine Tags: Dtsch Arztebl Int Source Type: research

Warfarin in nonvalvular atrial fibrillation-Time for a change?
Abstract Warfarin is the most commonly prescribed anticoagulant in hemodialysis (HD) patients with nonvalvular atrial fibrillation (NVAF). Recent trends show that Nephrologists are increasingly prescribing novel oral anticoagulants, despite the fact that no randomized clinical trials have been conducted in dialysis patients. Difficulties maintaining international normalized ratio in the therapeutic range, increased risk of intracranial hemorrhage and concerns regarding warfarin-induced vascular calcification and calciphylaxis may be responsible. Anticoagulation quality is poor in HD patients. A variety of factors ...
Source: Seminars in Dialysis - June 16, 2019 Category: Urology & Nephrology Authors: Reilly RF, Jain N Tags: Semin Dial Source Type: research