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Apixaban for Patients with Atrial Fibrillation on Hemodialysis: A Multicenter Randomized Controlled Trial
CONCLUSIONS: There was inadequate power to draw any conclusion regarding rates of major or clinically relevant non-major bleeding comparing apixaban and warfarin in patients with AF and ESKD on hemodialysis. Clinically relevant bleeding events were approximately 10-fold more frequent than stroke or systemic embolism among this population on anticoagulation, highlighting the need for future randomized studies evaluating the risks versus benefits of anticoagulation among patients with AF and ESKD on hemodialysis.PMID:36335914 | DOI:10.1161/CIRCULATIONAHA.121.054990
Source: Circulation - November 6, 2022 Category: Cardiology Authors: Sean D Pokorney Glenn M Chertow Hussein R Al-Khalidi Dianne Gallup Pat Dignaco Kurt Mussina Nisha Bansal Crystal A Gadegbeku David A Garcia Samira Garonzik Renato D Lopes Kenneth W Mahaffey Kelly Matsuda John P Middleton Jennifer A Rymer George H Sands Ra Source Type: research

Direct Oral Anticoagulant Use in Special Populations: Elderly, Obesity, and Renal Failure
AbstractPurpose of ReviewThe purpose of this review is to examine the safety and effectiveness of direct oral anticoagulants and provide recommendations for the treatment of venous thromboembolism and atrial fibrillation in obese patients, elderly patients, and patients with chronic kidney disease.Recent FindingsMultiple retrospective cohort studies have shown no difference in bleeding, stroke, or venous thromboembolism outcomes between DOACs and warfarin in patients who are obese, elderly, or those with chronic kidney disease or on dialysis. Some studies have shown that DOACs have a lower bleeding risk than warfarin in th...
Source: Current Cardiology Reports - March 2, 2021 Category: Cardiology Source Type: research

Effect of Rivaroxaban or Apixaban in Atrial Fibrillation Patients with Stage 4 –5 Chronic Kidney Disease or on Dialysis
ConclusionsCurrent evidence suggests that rivaroxaban or apixaban are safe and at least as effective as warfarin in patients with AF and stage 4 –5 CKD or on dialysis.
Source: Cardiovascular Drugs and Therapy - February 4, 2021 Category: Cardiology Source Type: research

Effectiveness and Safety of Direct Oral Anticoagulants in an Asian Population with Atrial Fibrillation Undergoing Dialysis: A Population-Based Cohort Study and Meta-Analysis
ConclusionsDOACs did not provide benefit over warfarin regarding effectiveness and safety in AF patients undergoing dialysis. The use of OAC was not associated with a lower risk of IS/SE in ESRD AF patients when compared to those without OAC use.
Source: Cardiovascular Drugs and Therapy - November 19, 2020 Category: Cardiology Source Type: research

Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis
ConclusionThere is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis.
Source: American Journal of Cardiovascular Drugs - April 22, 2019 Category: Cardiology Source Type: research

Relation of Race, Apparent Disability, and Stroke Risk With Warfarin Prescribing for Atrial Fibrillation in Patients Receiving Maintenance Hemodialysis
We examined patterns of warfarin use, and associated factors, after AF diagnosis. This retrospective cohort analysis studied US Medicare patients receiving maintenance dialysis January 1, 2008-June 30, 2010. Demographics, comorbidity, and a durable medical equipment claims-based disability proxy score predicted warfarin prescription after AF diagnosis. The analysis included 8964 patients with non-valvular AF.
Source: The American Journal of Cardiology - November 24, 2018 Category: Cardiology Authors: James B. Wetmore, Yi Peng, David T. Gilbertson, Jiannong Liu Source Type: research

Outcomes Associated with Apixaban Use in End-Stage Kidney Disease Patients with Atrial Fibrillation in the United States.
Conclusions -Among ESKD patients with AF on dialysis, apixaban use may be associated with lower risk of major bleeding compared with warfarin, with a standard 5 mg twice a day dose also associated with reductions in thromboembolic and mortality risk. PMID: 29954737 [PubMed - as supplied by publisher]
Source: Circulation - June 28, 2018 Category: Cardiology Authors: Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, Tilea A, Stack AG, Balkrishnan R, Yao X, Noseworthy PA, Shah ND, Saran R, Nallamothu BK Tags: Circulation Source Type: research

‘Some doors are better left closed’: Using LAA occluders as an alternative to warfarin in very high-risk dialysed patients with atrial fibrillation
Since 2011, when the EMA approved the treatment with novel oral anticoagulants (NOACs) for primary prevention of cardio-embolic stroke in patients with atrial fibrillation (AF), a reasonable question repeatedly arose: “Will NOACs become the new standard of care in anticoagulation therapy?” [1]. While for many cathegories of patients the answer soon become positive [2], the sub-group of advanced chronic kidney disease (CKD) 5D stage (in dialysis) has never received a “yes” from either FDA or EMA (none of t hem allowing the use of NOACs in 5D CKD).
Source: International Journal of Cardiology - April 27, 2018 Category: Cardiology Authors: Alexandru Burlacu, Adrian Covic Tags: Editorial Source Type: research

Warfarin and the risk of stroke and bleeding in patients with atrial fibrillation receiving dialysis: A systematic review and meta-analysis
Conclusion Observational studies suggest that warfarin was not associated with a clear benefit or harm among patients who have atrial fibrillation and are receiving dialysis. These estimates were limited by study heterogeneity including the inability to account for a number of important confounders such as the time in the therapeutic range. Given the high prevalence of atrial fibrillation, stroke, and bleeding complications in this population, well-designed clinical trials of warfarin and other anti-coagulants are urgently needed. Teaser Patients with atrial fibrillation receiving maintenance dialysis are at a high risk of...
Source: Canadian Journal of Cardiology - February 20, 2017 Category: Cardiology Source Type: research

Anticoagulation for atrial fibrillation in dialysis patients: What is known and what does the future hold?
The association between atrial fibrillation and stroke is well established, and in the general population, anticoagulation with warfarin can reduce the incidence of stroke by 60% with an acceptable bleeding risk.1,2 Patients who are on hemodialysis have an increased prevalence of atrial fibrillation, possibly secondary to comorbid conditions and hemodialysis itself causing dramatic swings in fluid and electrolytes and affecting cardiac dimensions.3 There are also substantially higher rates of ischemic stroke in this population attributable both to frequently co-occurring traditional stroke risk factors and to the increased...
Source: Heart Rhythm - February 18, 2017 Category: Cardiology Authors: Timothy M. Markman, Saman Nazarian Tags: Editorial Commentary Source Type: research

Editorial Commentary: Anticoagulation for atrial fibrillation in dialysis patients: What is known and what does the future hold?
The association between atrial fibrillation and stroke is well established and, in the general population, anticoagulation with warfarin can reduce the incidence of stroke by 60% with an acceptable bleeding risk.1, 2 Patients who are on hemodialysis have an increased prevalence of atrial fibrillation possibly secondary to comorbid conditions and hemodialysis itself causing dramatic swings in fluid and electrolytes and affecting cardiac dimensions.3 There are also substantially higher rates of ischemic stroke in this population attributable both to frequently co-occurring traditional stroke risk factors as well as the incre...
Source: Heart Rhythm - February 18, 2017 Category: Cardiology Authors: Timothy M. Markman, Saman Nazarian Source Type: research

Warfarin Use and the Risk of Mortality, Stroke, and Bleeding in Hemodialysis Patients with Atrial Fibrillation
The optimal management of stroke prophylaxis in hemodialysis patients with atrial fibrillation is controversial.
Source: Heart Rhythm - February 5, 2017 Category: Cardiology Authors: Brandon Kai, Yuliya Bogorad, Leigh-Ann N. Nguyen, Su-Jau Yang, Wansu Chen, Hillard T. Spencer, Albert Y.-J. Shen, Ming-Sum Lee Source Type: research

Atrial Fibrillation and Chronic Kidney Disease Requiring Hemodialysis – Does Warfarin Therapy Improve the Risks of this Lethal Combination?
Warfarin therapy for stroke prevention is recommended for patients with AF, but its value in patients with chronic kidney disease on HD is unknown.
Source: International Journal of Cardiology - July 7, 2016 Category: Cardiology Authors: Lohit Garg, Charity Chen, David E. Haines Source Type: research

Atrial fibrillation and chronic kidney disease requiring hemodialysis — Does warfarin therapy improve the risks of this lethal combination?
Warfarin therapy for stroke prevention is recommended for patients with AF, but its value in patients with chronic kidney disease on HD is unknown.
Source: International Journal of Cardiology - July 7, 2016 Category: Cardiology Authors: Lohit Garg, Charity Chen, David E. Haines Source Type: research

Nonvitamin K Anticoagulant Agents in Patients With Advanced Chronic Kidney Disease or on Dialysis With AF
Nonvitamin K-dependent oral anticoagulant agents (NOACs) are currently recommended for patients with atrial fibrillation at risk for stroke. As a group, NOACs significantly reduce stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with warfarin. All NOACs are dependent on the kidney for elimination, such that patients with creatinine clearance 
Source: Journal of the American College of Cardiology - June 14, 2016 Category: Cardiology Source Type: research

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