The following is a summary of “Treatment strategies of the thromboembolic risk in kidney failure patients with atrial fibrillation,” published in the May 2024 issue of Nephrology by Genovesi et al.
Many patients with kidney failure who have a glomerular filtration rate under 15 ml/min/1.73m2 also suffer from atrial fibrillation (AF).
Researchers conducted a retrospective study to determine how to prevent thromboembolic events in these patients because cardiology and nephrology guidelines are vague.
They studied oral anticoagulant therapy (OAC), such as vitamin K antagonists (VKA) or direct anticoagulants (DOAC), which was safe and effective in preventing thromboembolism in patients with kidney failure and AF. Patients with <25-30 ml/min creatinine clearance were excluded from the RCTs. Three trials comparing DOACs and VKAs didn’t get precise results because of the small number of participants.
The results showed that the left atrial appendage (LAA) is the primary source of thromboembolism in the presence of AF. The LAA closure (LAAC) has been proposed as a new alternative to OAC. The RCTs comparing LAAC to OAC in kidney failure were stopped early due to recruitment failure. A recent study also showed fewer clots in dialysis patients with AF who had LAAC compared to those on or off OAC.
Investigators concluded that current treatments and new developments for reducing thromboembolic risk in patients with kidney failure having AF need review.
Source: academic.oup.com/ndt/advance-article-abstract/doi/10.1093/ndt/gfae121/7685545
