28 Feb Study Weighs Risks/Benefits of Oral Anticoagulation for Atrial Fibrillation in Hemodialysis Patients
MedicalResearch.com Interview with: Dr. Simonetta Genovesi MD
Department of Health Science
University of Milano-Bicocca, Monza
Italy Nephrology Unit
San Gerardo Hospital, Monza, Italy
MedicalResearch: What is the background for this study?
Dr. Genovesi: The prevalence of atrial fibrillation (AF) in patients
with end-stage renal disease (ESRD) on hemodialysis (HD)
is high. The presence of atrial fibrillation increases the risk of
thrombo-embolic stroke in the general population. The
treatment of choice for reducing thrombo-embolic risk in
AF patients is oral anticoagulant therapy (OAT) with
warfarin. However, the use of warfarin in HD patients is
controversial because of the high risk of bleeding and the
fact that it is not demonstrated a clear protection
against the risk of stroke in this population. The purpose
of the study was to prospectively evaluate the effect of
OAT on the risk of mortality, stroke and bleeding in HD
population.
MedicalResearch: What are the main findings?
Dr. Genovesi: In our hemodialysis population oral anticoagulant therapy does not increase the risk of total mortality, while antiplatelet agents are associated
with an increased risk of death of about 70%. The
continuous use of warfarin tends to be associated with
improved survival as compared with individuals who
discontinued the medication during the follow-up, but the
incidence of thrombo-embolic events is not different in
OAT subjects as compared with those who do not take it.
Moreover, bleeding events are more frequent in patients
taking warfarin, although the maintenance over time of an
INR in the therapeutic range wards against the risk of
bleeding.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Genovesi: In our study oral anticoagulant therapy is not associated with increased mortality, while it does not seem to be related to a
decreased incidence of ischemic stroke, whereas it
increases the incidence of bleeding. However, the risk of
bleeding is reduced in subjects in whom INR is constantly
kept within the therapeutic range . A careful evaluation
of the hemorrhagic risk before embarking on an OAT in an
ESRD patient remains of paramount clinical importance.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Genovesi: Many of our findings may be useful in regard to the issue
of anticoagulation in hemodialysis patients with AF, but larger
prospective studies and randomized trials are needed to
provide nephrologists with additional elements concerning
how to treat such patients.
Citation:
Nephrol Dial Transplant. 2015 Mar;30(3):491-8. doi: 10.1093/ndt/gfu334. Epub 2014 Oct 28.
Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation.
MedicalResearch.com Interview with:, & Dr. Simonetta Genovesi MD (2015). Study Weighs Risks/Benefits of Oral Anticoagulation for Atrial Fibrillation in Hemodialysis Patients MedicalResearch.com
Last Updated on February 28, 2015 by Marie Benz MD FAAD