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The nephrologist’s anticoagulation treatment patterns/regimens in chronic hemodialysis patients with atrial fibrillation

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Abstract

Background

The prevalence of atrial fibrillation (AF) is high in hemodialysis (HD) patients. It was suggested that oral anticoagulant therapy (OAT), the choice treatment for reducing the thromboembolic risk in AF patients, increases the incidence of both ischemic and hemorrhagic strokes in the HD population. Moreover, the therapy-related bleeding risk is particularly high in these patients. For these reasons there is no agreement on the use of OAT in HD patients with AF. The aim of this study was to evaluate the criteria adopted by nephrologists in prescribing OAT in HD patients with AF.

Methods

All the patients presenting AF (paroxysmal, persistent or permanent) at 31/10/2010 (n = 290) were recruited from 1529 HD patients from ten Italian HD centres. To detect factors related to OAT administration the main clinical features, CHADS2 and HASBLED scores were evaluated in logistic regression models.

Results

The presence of permanent AF (OR = 4.28, p < 0.0001) was the only clinical factor directly associated to OAT administration, while previous bleedings (OR = 0.35, p = 0.004) were inversely related. The CHADS2 score was not associated with OAT prescription (OR = 0.85, p = 0.08), while an inverse relation was found with the hemorrhagic risk score (OR = 0.74, p = 0.03).

Conclusion

A high AF prevalence was observed in our HD population, but less than 50 % of these patients received OAT. Patients with permanent AF were more frequently treated with warfarin, while OAT administration was uncommon in those with previous bleedings. The thromboembolic risk score was not associated with warfarin prescription, while there was an inverse relation with the hemorrhagic risk score.

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Conflict of interest

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Authors and Affiliations

  1. Department of Health Science, University of Milano-Bicocca, Monza, Italy

    Simonetta Genovesi, Daniela Pogliani & Andrea Stella

  2. Department of Health Science, Medical Statistic Unit, University of Milano-Bicocca, Monza, Italy

    Emanuela Rossi & Maria Grazia Valsecchi

  3. Nephrology Unit, San Gerardo Hospital, Monza, Italy

    Simonetta Genovesi & Andrea Stella

  4. Nephrology Unit, San Carlo Borromeo Hospital, Milano, Italy

    Maurizio Gallieni

  5. Nephrology Unit, Infermi Hospital, Rimini, Italy

    Fabio Badiali

  6. Nephrology Unit, S. Uboldo Hospital, Cernusco sul Naviglio, Italy

    Ferruccio Conte

  7. Nephrology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy

    Sonia Pasquali

  8. Nephrology Unit, IRCCS Multimedica, Sesto S. Giovanni, Italy

    Silvio Bertoli

  9. Nephrology Unit, Ospedali Riuniti, Bergamo, Italy

    Patrizia Ondei

  10. Nephrology Unit, S. Anna Hospital, Como, Italy

    Giuseppe Bonforte

  11. Nephrology Unit, Bassini Cinisello Hospital, Milano, Italy

    Claudio Pozzi

  12. Nephrology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy

    Antonio Santoro

Authors
  1. Simonetta Genovesi
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  2. Emanuela Rossi
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  3. Daniela Pogliani
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  4. Maurizio Gallieni
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  9. Silvio Bertoli
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  11. Giuseppe Bonforte
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  13. Maria Grazia Valsecchi
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  14. Antonio Santoro
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Corresponding author

Correspondence to Simonetta Genovesi.

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Genovesi, S., Rossi, E., Pogliani, D. et al. The nephrologist’s anticoagulation treatment patterns/regimens in chronic hemodialysis patients with atrial fibrillation. J Nephrol 27, 187–192 (2014). https://doi.org/10.1007/s40620-013-0030-3

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  • DOI: https://doi.org/10.1007/s40620-013-0030-3

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