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International Urology and Nephrology

, Volume 50, Issue 9, pp 1633–1642 | Cite as

Atrial fibrillation in dialysis patients: is there a place for non-vitamin K antagonist oral anticoagulants?

  • Elzbieta Mlodawska
  • Paulina Lopatowska
  • Jolanta Malyszko
  • Maciej Banach
  • Bożena Sobkowicz
  • Adrian Covic
  • Anna Tomaszuk-KazberukEmail author
Nephrology - Review

Abstract

Atrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin. Nevertheless according to ESC guidelines, NOACs are not recommended in patients with creatinine clearance < 30 mL/min. Observational studies provide contradictive data. Only few new trials are ongoing. Therefore, it is not clear if NOACs should be in the future prescribed to patients with advanced CKD and those on dialysis. Moreover, the risk of stroke and bleeding is much higher in such population than in patients without end-stage renal disease (ESRD). The authors provide data on pros and cons of use of NOACs in ESRD patients with AF.

Keywords

Atrial fibrillation Dialysis Non-vitamin K antagonist oral anticoagulants 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interests.

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Authors and Affiliations

  1. 1.Department of CardiologyMedical University in BialystokBiałystokPoland
  2. 2.Department of Nephrology, Dialysis and Internal MedicineWarsaw Medical UniversityWarsawPoland
  3. 3.Department of Hypertension, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
  4. 4.Nephrology ClinicDialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital, and ‘Grigore T. Popa’ University of MedicineIasiRomania
  5. 5.Department of CardiologyUniversity Hospital in BialystokBiałystokPoland

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