Anticoagulants that are used to prevent strokes in dialysis patients suffering from atrial fibrillation are not adequate for this particular population. This was the conclusion of a study by Oliver Konigsbrugge, Cihan Ay and Cihan Ay, all from the Department of Medicine I at MedUni Vienna/Vienna General Hospital. The study was done in collaboration with seven dialysis centers located in Vienna.
Atrial fibrillation is a disorder that causes irregular heartbeats and may cause a high risk of stroke. The VIVALDI study (Vienna Investigation of Thromboembolism and Arial Fibrillation among Patients with Atrial Fibrillation on Hemodialysis) that was conducted by Cihan Ay and Oliver Konigsbrugge from the Department of Medicine I at MedUni Vienna and highlights the need to prevent strokes in dialysis patients.
The proportion of patients with atrial fibrillation is especially high among patients receiving haemodialysis and is in excess of 25%. Strokes and other cardiovascular events are significant contributors to the mortality rate. Analyzing the cardiovascular events that occurred during the time of observation found that, contrary expectations, patients who received anticoagulation therapy with the vitamin K antagonist phenprocoumon demonstrated no benefit in terms of decreasing stroke risk, but had a higher rate of major bleeding.”
Cihan Ay, Department of Medicine I at MedUni Vienna and Vienna General Hospital
The VIVALDI study was conducted in collaboration with seven dialysis centers in Vienna. Over a period of up to 45 months, a sample of 625 patients receiving haemodialysis was followed. Patients with atrial fibrillation had an average of 4.8% per year of thromboembolic events (strokes or systemic embolisms). 8.4 percent of patients a year suffered major bleeding. Ay states that the high prevalence of thromboembolic complications among haemodialysis patients demonstrates the necessity of providing patients with anticoagulation therapy that is equally effective in stopping strokes and safe to administer for cutting the risk of bleeding.
Stroke prevention in atrial fibrillation is well studied in the general population. Studies have proven that treatment using direct oral anticoagulants (DOACs) is effective for a long time. This type of medication has been withheld from patients with permanent kidney failure and who require dialysis due to the absence of relevant studies. Only medications from the vitamin K antagonist class are currently approved for oral anticoagulants for haemodialysis patients in Germany-speaking countries. Clinical trials are in progress to determine the effectiveness of direct oral anticoagulants (DOAC) for patients on haemodialysis. “It would appear that there is an urgent need to improve current practices in clinical practice to prevent strokes in haemodialysis patients. We are therefore eagerly awaiting the results of the clinical study,” Ay. Ay.
Konigsbrugge, O., and. (2021) Anticoagulation use and the risk of major bleeding and stroke in patients on hemodialysis. From VIVALDI study, a population-based prospective cohort study. Journal of Thrombosis and Haemostasis. doi.org/10.1111/jth.15508.
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