Abstract

GANDARA-RICARDO, Jairo A.; SIERRA-VARGAS, Elsy C.; PLAZA-TENORIO, Maribel  and  RODELO-CEBALLOS, Joaquín. The dilemma of anticoagulation in patients with atrial fibrillation and stage 5 chronic kidney disease. Rev. Colomb. Cardiol. [online]. 2022, vol.29, n.4, pp.467-474.  Epub Nov 08, 2022. ISSN 0120-5633.  https://doi.org/10.24875/rccar.21000039.

Currently, there is no solid evidence regarding safety and efficacy of anticoagulation therapy in patients with non-valvular atrial fibrillation and stage 5 chronic kidney disease, as this population has been excluded from randomized controlled clinical trials. The decision to start anticoagulation in such setting has been based in results of observational studies with warfarin, some reporting an increase incidence of both bleeding and stroke, and with apixaban which was associated with a significant reduction in bleeding, stroke and death risk, compared to warfarin. Recent evidence suggests that, in patients with atrial fibrillation on hemodialysis, anticoagulation with apixaban does not reduce the incidence of stroke, but it is associated with a higher bleeding rate compared to no therapy at all. A narrative review of the literature was performed and a therapeutic approach is proposed for anticoagulation in patients with non-valvular atrial fibrillation and stage 5 chronic kidney disease.

Keywords : Atrial fibrillation; Renal insufficiency; Dialysis; Anticoagulants; Hemorrhage.

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