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< Vol. 39 Issue 3 | Mar 2016 | pp. 99 - 146

Atrial fibrillation in dialysis patients: time to abandon warfarin?

Atrial fibrillation in dialysis patients: time to abandon warfarin?

Int J Artif Organs 2016; 39(3): 99 - 105

Article Type: REVIEW

DOI:10.5301/ijao.5000487

Authors

Diego Brancaccio, Luca Neri, Francesco Bellocchio, Carlo Barbieri, Claudia Amato, Flavio Mari, Bernard Canaud, Stefano Stuard

Abstract

Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis. Ideally the most promising therapy would be based on direct inhibitors of factor IIa or Xa; however, at the moment, none of these drugs can be safely prescribed in dialysis patients, because of their potentially dangerous accumulation, and the lack of sufficient experience with apixaban or rivaroxaban, two drugs showing a favorable pharmacokinetic profile in end-stage renal disease. Hence, the use of vitamin K inhibitors is currently the only pharmacological option for stroke prevention in dialysis patients with atrial fibrillation, leaving the clinicians in a management conundrum.

This review discusses the trade-offs implicated in warfarin use for this population, the promises of newly developed drugs, the role of dialysis as atrial fibrillation trigger, as well as potential non-pharmacological management options suitable in selected clinical situations.

Article History

  • • Accepted on 06/03/2016
  • • Available online on 09/04/2016
  • • Published in print on 16/05/2016

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: All authors are Fresenius employees.

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Authors

  • Brancaccio, Diego [PubMed] [Google Scholar] 1, * Corresponding Author ([email protected])
  • Neri, Luca [PubMed] [Google Scholar] 2
  • Bellocchio, Francesco [PubMed] [Google Scholar] 2
  • Barbieri, Carlo [PubMed] [Google Scholar] 2
  • Amato, Claudia [PubMed] [Google Scholar] 2
  • Mari, Flavio [PubMed] [Google Scholar] 2
  • Canaud, Bernard [PubMed] [Google Scholar] 3
  • Stuard, Stefano [PubMed] [Google Scholar] 3

Affiliations

  • Dialysis Unit NephroCare Simone Martini, Milan - Italy
  • Fresenius Medical Care, Palazzo Pignano - Italy
  • Fresenius Medical Care, Bad Homburg - Germany
  • Diego Brancaccio and Luca Neri contributed equally to this manuscript.

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