Are Anticoagulants Safe in AF With Hemodialysis?

A team of Taipei City Hospital researchers say the results of their recent study show that using oral anticoagulants in patients with new-onset atrial fibrillation (AF) who need hemodialysis may remain controversial, but the risk of stroke is only “modestly higher” in these patients compared to those without AF.

In an effort to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF in comparison to those without arrhythmia, investigators from the hospital conducted their study using data from Taiwan’s National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset non-valvular AF, and matched subjects without arrhythmia.
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In total, the researchers identified 6,494 patients with AF and 6,494 matched controls with similar baseline characteristics. The clinical end points were ischemic stroke (fatal or non-fatal), all-cause death, and other serious adverse cardiovascular events. In comparison to the matched cohort, patients with AF demonstrated higher risks of ischemic stroke, all-cause death, in-hospital cardiovascular death, myocardial infarction, and hospitalization for heart failure. While the risk of stroke was only slightly higher in new-onset AF patients undergoing hemodialysis than those without AF, the authors say this difference became “insignificant when accounting for the competing risk of in-hospital death.”

As such, the findings suggest that “the association of new-onset AF with subsequent ischemic stroke was weaker than as previously expected in patients on chronic hemodialysis,” says Yung-Tai Chen, MD, a physician in the nephrology department at Taipei City Hospital, and co-author of the study.

“Besides, there is no strong evidence regarding the use of oral anticoagulants for stroke prevention in patients undergoing hemodialysis with atrial fibrillation,” he says, adding that the results have implications that could lead to “reconsideration of the need of oral anticoagulants for stroke prevention.”

—Mark McGraw

Reference

Shih CJ, Ou SM, et al. Risks of death and stroke in patients undergoing hemodialysis with new-onset atrial fibrillation: A competing-risk analysis of a nationwide cohort. Circ. 2016.