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Anticoagulation Dangers For AF Patients With Renal Disease

The risks and benefits of anticoagulation therapy in patients with atrial fibrillation (AF) and severe renal impairment are poorly understood and require further study, according to a report published recently in the Journal of the American College of Cardiology (doi:10.1016/j.jacc.2010.12.013).

Researchers led by Dr Ricarda Marinigh, University of Birmingham, performed a comprehensive literature search using electronic bibliographic databases, scanning reference lists from included articles and hand searching abstracts from national and international cardiovascular meetings. Search terms included atrial fibrillation, renal failure, dialysis, stroke, bleeding/hemorrhage, and thromboprophylaxis.

In a semi-systematic review of what they describe as “a vast amount of literature of relatively poor general quality,” the authors point out that current stroke risk stratification schemes are based on studies that actively excluded patients with severe renal failure. There are no large randomised controlled trials that assess the real risk/benefit of full intensity anticoagulation in patients with severe renal impairment, they claim, although rates of major bleeding episodes in anticoagulated haemodialysis patients with AF are high.

The study concludes that anticoagulation remains the best option for reducing stroke and bleeding risk in AF patients with severe renal impairment. In the absence of high-quality evidence and large prospective randomised clinical trials that have specifically investigated this population, however, they emphasise that the treatment must be well-controlled, with regular review and reassessment of risk profile for individual patients.

Published on: April 6, 2011

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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