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Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

Journal of Stroke 2020년 22권 3호 p.306 ~ 316
Goel Narender, Jain Deepika, Haddad Danny B., Shanbhogue Divya,
소속 상세정보
 ( Goel Narender ) - New Jersey Kidney Care
 ( Jain Deepika ) - New Jersey Kidney Care
 ( Haddad Danny B. ) - New Jersey Kidney Care
 ( Shanbhogue Divya ) - Jersey City Medical Center Department of Medicine

Abstract


End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA2DS2-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

키워드

Kidney failure, chronic; Atrial fibrillation; Anticoagulants; Stroke

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