Study: Oral Anticoagulants for Patients Initiating Dialysis with Existing Atrial Fibrillation or Flutter

Systemic oral anticoagulants may decrease the risk of ischemic stroke in patients with atrial fibrillation or flutter (Afib). In the general patient population, those with a CHA₂DS₂-VASc risk score of ≥ 2 are thought to be at a moderate-high risk for stroke and will likely benefit from oral anticoagulation. However, for patients who begin hemodialysis with Afib, the usefulness of the CHA₂DS₂-VASc score is unclear due to these patients’ higher rate of comorbidities and greater risk of bleeding. DaVita Clinical Research conducted a study among patients initiating hemodialysis with preexisting Afib to:

• Assess how choosing to use oral anticoagulants versus not to use oral anticoagulants at the time of dialysis initiation influences key clinical outcomes and
• Examine how the relationship between choosing to use oral anticoagulants at dialysis initiation and clinical outcomes is related to the CHA₂DS₂-VASc risk score.

The study indicated that, after accounting for differences in baseline characteristics, there were no apparent differences in outcomes between patients who were and were not prescribed oral anticoagulants. There was also no relationship between the CHA₂DS₂-VASc score and the probability that patients had filled a prescription for an oral anticoagulant, and ultimately no evidence that the CHA₂DS₂-VASc risk score can effectively indicate the potential benefits of systemic oral anticoagulants for patients initiating hemodialysis with preexisting Afib.

Additional research is necessary to further guide using anticoagulants in this population.

For more information, read the research poster (which was presented at ASN) here.