Abstract
Background and Aims
Progress has been made over the past six decades in the world of hemodialysis, however it still remained as an ongoing challenge for clinicians since it is coupled with an increasing incidence of dysrhythmia that brings a high cardiac mortality in the first year. Many of these patients will have a risk profile lending to oral anticoagulation with warfarin as the traditionally mainstay of therapy for this indication or a non-vitamin K oral anticoagulants (NOACs) in some because of ease of administration and comparable efficacy. There may be convincing as well as contrasting arguments regarding its use, but without well-conducted clinical trials, it is definitely impossible to consider the indication of oral anticoagulation therapy in this special group of population.
This study aims to determine the difference in clinical outcomes between oral anticoagulation and no anticoagulation therapy among End-Stage Renal Disease patients on maintenance hemodialysis with atrial fibrillation in Perpetual Succour Hospital, and to provide local data on the prevalence and frequency of oral anticoagulation and no anticoagulation therapy in this group of patients.
Method
This is a single-center, prospective, observational cohort study conducted in a tertiary hospital in Cebu City, Cebu. All diagnosed End-Stage Renal Disease patients with chronic atrial fibrillation on maintenance hemodialysis for at least 3 months.
Results
A total of 188 ESRD patients on maintenance hemodialysis at The Kidney Service-Perpetual Succour Hospital were identified from May 1, 2017 through October 31, 2018, of which 74 (39.4%) subjects had a documented coexisting chronic atrial fibrillation at the time of recruitment but only 69 individuals were included in the analysis. At enrollment, 59 (85.5%) patients were identified to have no oral anticoagulation therapy and 10 (14.5%) were already receiving oral anticoagulation. Ischemic strokes was more prevalent (80%, p=<0.0001) among patients who were on oral anticoagulant. Likewise, patient differ significantly in terms of intracranial hemorrhage (30%, p= 0.0004) and gastrointestinal bleeding (50%, p= <0.00001) were noted among patients receiving oral anticoagulation therapy. In relation to over-all mortality, acute myocardial infarction, peripheral arterial occlusive disease and caciphylaxis, there was no sufficient evidence to show significant difference between two groups.
Conclusion
This study suggests that the use of oral anticoagulation did not prevent ischemic strokes in ESRD patients on maintenance hemodialysis with chronic atrial fibrillation. Further, it was associated with increased risk for intracranial hemorrhage and gastrointestinal bleeding. Lastly, there was no significant difference in relation to all-cause mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis between the two study groups.
A yearlong monitoring of the quality of oral anticoagulation therapy in patients with atrial fibrillation and analysis of its influence on the quality of anticoagulation