Abstract
Background and Objectives: Although the need for anticoagulation to prevent thromboembolism is increasing and non-vitamin K antagonist oral anticoagulants (NOACs) have been tried, there is still controversy about the efficacy of anticoagulation in patients with dialysis. Materials and Methods: We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with atrial fibrillation (AF). We retrospectively analyzed all data of 89 patients who received dialysis therapy and were diagnosed with AF. Among them, 27 received anticoagulation (11 warfarin and 16 apixaban 2.5 mg twice a day), while 62 received no anticoagulation. Results: In multivariate Cox regression analysis, compared to no anticoagulation treatment, anticoagulation treatment was associated with a low incidence of all-cause mortality (hazard ratios (HR) 0.36; 95% confidence interval (CI) 0.15–0.88). Compared to no anticoagulation treatment, more anticoagulation treatment patients experienced severe bleeding (HR 4.67; 95% CI 1.26–17.25) and any bleeding (HR 2.79; 95% CI 1.01–7.74). Compared to no anticoagulation, warfarin treatment patients were associated with a low incidence of all-cause mortality (HR 0.26; 95% CI 0.09–0.81) and a high incidence of severe bleeding (HR 4.85; 95% CI 1.12–21.10). All-cause mortality and bleeding were not significantly different between no anticoagulation and apixaban treatment patients. Conclusions: In dialysis patients with AF, anticoagulation therapy is associated with an increased incidence of severe bleeding, but anticoagulation therapy is associated with a low incidence of all-cause mortality. Individualized anticoagulation therapy with careful bleeding monitoring is needed in dialysis patients with AF.
Highlights
Atrial fibrillation (AF) belongs to the category of supraventricular arrhythmia, and over 7–13% of patients on dialysis have this disease, which is 10–20-fold higher than the general population [1,2]
The multivariate-adjusted Cox regression analysis and the Kaplan–Meier curve analysis showed that, compared with no anticoagulation treatment, anticoagulation treatment was associated with a low incidence of all-cause mortality (HR 0.36; 95% confidence interval (CI) 0.15–0.88) and a high incidence of severe bleeding (HR 4.67; 95% CI 1.26–17.26) and any bleeding (HR 2.81; 95% CI, 1.01–7.81) (Figure 1)
In our study, compared with the no anticoagulation group, the anticoagulation group was associated with reduced incidence of all-cause mortality and increased incidence of severe bleeding and any bleeding
Summary
Atrial fibrillation (AF) belongs to the category of supraventricular arrhythmia, and over 7–13% of patients on dialysis have this disease, which is 10–20-fold higher than the general population [1,2]. The need for anticoagulation in patients with atrial AF on dialysis is increasing, there has been no randomized controlled trial (RCT) regarding the use of anticoagulation in this population. The need for anticoagulation to prevent thromboembolism is increasing and non-vitamin K antagonist oral anticoagulants (NOACs) have been tried, there is still controversy about the efficacy of anticoagulation in patients with dialysis. Warfarin treatment patients were associated with a low incidence of all-cause mortality (HR 0.26; 95% CI 0.09–0.81) and a high incidence of severe bleeding (HR 4.85; 95% CI 1.12–21.10). All-cause mortality and bleeding were not significantly different between no anticoagulation and apixaban treatment patients. Conclusions: In dialysis patients with AF, anticoagulation therapy is associated with an increased incidence of severe bleeding, but anticoagulation therapy is associated with a low incidence of all-cause mortality. Individualized anticoagulation therapy with careful bleeding monitoring is needed in dialysis patients with AF
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