Introduction: The delicate balance of risk versus benefit of oral anticoagulation in the general population is well established but the decision to use these agents in end-stage renal disease (ESRD) remains complex and difficult owing to the paucity of clinical trials and lack of substantial evidence in literature for its safe and effective use in the hemodialysis population. This study aims to determine the difference in clinical outcomes between oral anticoagulation and no anticoagulation therapy among ESRD patients on maintenance hemodialysis with atrial fibrillation. Methods: This is a prospective, single-center, observational study conducted in Perpetual Succour Hospital that included all ESRD patients on maintenance hemodialysis for at least 3 months with atrial fibrillation. Out of the 188 identified patients, only 69 patients were included in the study and were grouped according to how the cardiac dysrhythmia was approached either with oral anticoagulation or no use of oral anticoagulation. Basic demographic information were obtained as well as the etiology of ESRD, CHA2DS2-VASc Score and the HAS-BLED Score. Lastly, patients were prospectively followed for a period of 12 months and were then assessed for new onset of thromboembolic events, hemorrhagic events, calciphylaxis and all-cause mortality. Results: At enrollment, 59 (85.5%) patients were identified to have no oral anticoagulation therapy and 10 (14.5%) were already receiving oral anticoagulation. Ischemic strokes were more prevalent among patients who were on oral anticoagulant (80%, p <0.0001). Patient outcomes differ significantly in terms of intracranial hemorrhage (30%, p= 0.0004) and gastrointestinal bleeding (50%, p <0.00001) which were noted among patients on oral anticoagulation. In relation to over-all mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis, there was no significant difference between the two groups. Conclusion This study suggests that the use of oral anticoagulation did not prevent ischemic strokes in ESRD patients on maintenance hemodialysis with atrial fibrillation and its use was associated with increased risk for intracranial hemorrhage and gastrointestinal bleeding. There was no significant difference in relation to all-cause mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis between the two study groups.
Kidney Failure, Chronic ; Atrial Fibrillation