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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

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

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

Warfarin use and incidence of stroke in Japanese hemodialysis patients with atrial fibrillation
Abstract Atrial fibrillation (AF) is one of the major risk factor for ischemic stroke, and oral anticoagulation is generally indicated for prevention of stroke. However, the utility of oral anticoagulation for AF in dialysis patients remains controversial. In this single-center, retrospective, observational study, data from 1120 patients on maintenance hemodialysis were analyzed. Baseline medical data were collected from dialysis records including age, gender, the cause of end-stage renal disease, dialysis vintage, and comorbidities. We evaluated outcomes including stroke, major hemorrhage, and death. A total of 1...
Source: Heart and Vessels - December 8, 2015 Category: Cardiology Source Type: research

Clinical characteristics of hemodialysis patients with atrial fibrillation: The RAKUEN (Registry of atrial fibrillation in chronic kidney disease under hemodialysis from Niigata) study.
CONCLUSIONS: In our hemodialysis patients, AF was a common comorbidity and was independently associated with all-cause death and major bleeding, but not with increased risk of ischemic stroke. PMID: 26527113 [PubMed - as supplied by publisher]
Source: Journal of Cardiology - October 30, 2015 Category: Cardiology Authors: Mitsuma W, Matsubara T, Hatada K, Imai S, Saito N, Shimada H, Miyazaki S Tags: J Cardiol Source Type: research

Dabigatran and Rivaroxaban Use in Atrial Fibrillation Patients on Hemodialysis.
CONCLUSIONS: -More dialysis patients are being started on dabigatran and rivaroxaban, even when their use is contraindicated and there are no studies to support the benefits outweigh the risks of these drugs in ESRD. PMID: 25595139 [PubMed - as supplied by publisher]
Source: Circulation - January 16, 2015 Category: Cardiology Authors: Chan KE, Edelman ER, Wenger JB, Thadhani RI, Maddux FW Tags: Circulation Source Type: research

Warfarin Use and the Risk for Stroke and Bleeding in Patients with Atrial Fibrillation Undergoing Dialysis.
CONCLUSIONS: Our results suggest that warfarin use is not beneficial in reducing stroke risk but is associated with a higher bleeding risk in patients with AF undergoing dialysis. PMID: 24452752 [PubMed - as supplied by publisher]
Source: Circulation - January 22, 2014 Category: Cardiology Authors: Shah M, Avgil Tsadok M, Jackevicius CA, Essebag V, Eisenberg MJ, Rahme E, Humphries KH, Tu JV, Behlouli H, Guo H, Pilote L Tags: Circulation Source Type: research