Oral anticoagulation may do more harm than good in ESRD patients with atrial fibrillation

Use of oral anticoagulation (OAC) among patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) is low, reveals a study. OAC use does not appear to reduce the risk of stroke or death and is even associated with higher risks of hospitalization for bleeding or intracranial haemorrhage.

Of the 8,410 patients with AF and ESRD included in the analysis, 3,043 (36.2 percent) received OAC at some time during the study period. Propensity scores were used to match 1,519 patients with AF and ESRD on OAC with 3,018 ESRD patients not using OAC.

OAC use did not reduce hospitalization for stroke (hazard ratio [HR], 1.00, 95 percent confidence interval [CI], 0.23–1.35; p=0.097) or death (HR, 1.02, 95 percent CI, 0.94–1.10; p=0.62). Treatment with OAC also correlated with an increased risk of hospitalization for bleeding (HR, 1.26, 95 percent CI, 1.09–1.46; p=0.0017) and intracranial haemorrhage (HR, 1.30, 95 percent CI, 1.07–1.59; p=0.0094).

“Alternative stroke prevention strategies are needed in patients with ESRD and AF,” the authors noted.

Data from Medicare fee-for-service 5-percent claims from 2007 to 2013 were used to analyse treatment and outcomes in a cohort of patients with ESRD and AF. The timing of OAC therapy was determined using prescription drug benefit information.

The authors then compared outcomes including death, all-cause stroke, ischaemic stroke, haemorrhagic stroke and bleeding hospitalizations in ESRD patients treated with or without OAC using Cox proportional hazards modeling.

AF is common in patients with ESRD, according to the authors.