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Predicting in a predicament: Stroke and hemorrhage risk prediction in dialysis patients with atrial fibrillation.
Abstract Whether to anticoagulate dialysis patients with atrial fibrillation is a common clinical dilemma with limited high-quality data to inform decision-making. While the efficacy and safety of anticoagulation for stroke prevention in dialysis patients with atrial fibrillation has long been debated and remains unclear, the more upstream issue of stroke risk assessment from atrial fibrillation has received relatively little attention. In the general population, a handful of risk scores to help predict stroke and hemorrhage risk in the setting of atrial fibrillation are widely validated and applied in clinical pr...
Source: Seminars in Dialysis - July 11, 2017 Category: Urology & Nephrology Authors: Molnar AO, Sood MM Tags: Semin Dial Source Type: research

Evidence for the Prevention and Treatment of Stroke in Dialysis Patients.
Abstract The risks of both ischemic and hemorrhagic stroke are particularly high in dialysis patients of any age and outcomes are poor. It is therefore important to identify strategies that safely minimize stroke risk in this population. Observational studies have been unable to clarify the relative importance of traditional stroke risk factors such as blood pressure and cholesterol in those on dialysis, and are affected by biases that usually make them an inappropriate source of data on which to base therapeutic decisions. Well-conducted randomized trials are not susceptible to such biases and can reliably invest...
Source: Seminars in Dialysis - July 7, 2014 Category: Urology & Nephrology Authors: Herrington W, Haynes R, Staplin N, Emberson J, Baigent C, Landray M Tags: Semin Dial Source Type: research

Vitamin k antagonists: beyond bleeding.
Abstract Warfarin is the most widely used oral anticoagulant in clinical use today. Indications range from prosthetic valve replacement to recurrent thromboembolic events due to antiphospholipid syndrome. In hemodialysis (HD) patients, warfarin use is even more frequent than in the nonrenal population due to increased cardiovascular comorbidities. The use of warfarin in dialysis patients with atrial fibrillation requires particular caution because side effects may outweigh the assumed benefit of reduced stroke rates. Besides increased bleeding risk, coumarins exert side effects which are not in the focus of clinic...
Source: Seminars in Dialysis - January 1, 2014 Category: Urology & Nephrology Authors: Krüger T, Floege J Tags: Semin Dial 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