Warfarin safe and effective option for managing hemodialysis patients with AF

Egypt: In patients on dialysis who require anticoagulation for atrial fibrillation (AF), warfarin could be safe and efficient compared to direct oral anticoagulants (DOACs), states an article published in Frontiers in Cardiovascular Medicine. Compared to DOACs, warfarin was shown to be associated with a significant reduction in the rates of systemic embolization, minor bleeding, and death. 

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Patients with AF who have severe chronic kidney disease (CKD) requiring dialysis have significantly higher incidence rates of ischemic stroke. Also, patients who have end-stage renal disease (ESRD), have a higher risk of AF and an increase in the incidence of bleeding and complications. For a long, warfarin has been the cornerstone of anticoagulation in patients with AF. The safety of warfarin in patients on dialysis is questionable as it may cause a higher incidence of bleeding. Additionally, the efficacy of warfarin in stroke prevention among patients with AF who are on dialysis is also debatable. DOACs have been demonstrated to be non-inferior to warfarin in mild to moderate CKD.

The use of DOACs in patients who have both atrial fibrillation (AF) and end-stage renal disease (ESRD) requiring hemodialysis remains controversial, with warfarin remaining the mainstay of the treatment.

Sohil Elfar, Portsaid University, Egypt, and colleagues conducted a study to review the current evidence investigating the safety profile and the efficacy of DOACs in comparison with warfarin in patients with AF and end-stage renal disease (ESRD) requiring hemodialysis.