Anticoagulation in patients with atrial fibrillation (AF) who are on dialysis may cause harm.
In a systematic review and meta-analysis of 20 observational studies involving 31,321 patients with AF and end-stage renal disease on dialysis, there were unexpected associations of anticoagulation.
Findings include unfavorable or nonsignificant associations of anticoagulation use with any stroke, ischemic stroke, cardiovascular death, and all-cause mortality.
A substantial incidence of these outcomes in patients with AF on dialysis, and these were also inconsistent with any clear benefit of anticoagulation in this population.
The benefits of anticoagulation with stroke risk may not extend to dialysis patients with AF.
The Danish Dialysis Outcomes and Practice Patterns Study (DOPPS) found increased risk of stroke in dialysis patients with AF on warfarin, especially elderly patients, and retrospective analyses have not supported reductions in ischemic stroke with anticoagulation in this population.
Unavorable risk-benefit of anticoagulation for patients with AF on dialysis.
Evidence does not support the routine use of anticoagulation in this setting.
Meta-analysis of observational studies of patients with AF on dialysis failed to find any clear benefit of anticoagulation in this population.
Results showed significant increases of any type of stroke, hemorrhagic stroke, and any bleeding.
Risk of ischemic stroke was increased, though the results were not significant.