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.
| Original language | English |
|---|---|
| Pages (from-to) | 187-192 |
| Number of pages | 6 |
| Journal | Journal of Nephrology |
| Volume | 27 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 2014 |
Fingerprint
Keywords
- Atrial fibrillation
- Bleeding
- Hemodialysis
- Oral anticoagulant therapy
- Stroke
ASJC Scopus subject areas
- Nephrology
- Medicine(all)
Cite this
The nephrologist's anticoagulation treatment patterns/regimens in chronic hemodialysis patients with atrial fibrillation. / Genovesi, Simonetta; Rossi, Emanuela; Pogliani, Daniela; Gallieni, Maurizio; Stella, Andrea; Badiali, Fabio; Conte, Ferruccio; Pasquali, Sonia; Bertoli, Silvio; Ondei, Patrizia; Bonforte, Giuseppe; Pozzi, Claudio; Valsecchi, Maria Grazia; Santoro, Antonio.
In: Journal of Nephrology, Vol. 27, No. 2, 2014, p. 187-192.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The nephrologist's anticoagulation treatment patterns/regimens in chronic hemodialysis patients with atrial fibrillation
AU - Genovesi, Simonetta
AU - Rossi, Emanuela
AU - Pogliani, Daniela
AU - Gallieni, Maurizio
AU - Stella, Andrea
AU - Badiali, Fabio
AU - Conte, Ferruccio
AU - Pasquali, Sonia
AU - Bertoli, Silvio
AU - Ondei, Patrizia
AU - Bonforte, Giuseppe
AU - Pozzi, Claudio
AU - Valsecchi, Maria Grazia
AU - Santoro, Antonio
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Bleeding
KW - Hemodialysis
KW - Oral anticoagulant therapy
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84901022284&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84901022284&partnerID=8YFLogxK
U2 - 10.1007/s40620-013-0030-3
DO - 10.1007/s40620-013-0030-3
M3 - Article
C2 - 24430763
AN - SCOPUS:84901022284
VL - 27
SP - 187
EP - 192
JO - Journal of Nephrology
JF - Journal of Nephrology
SN - 1121-8428
IS - 2
ER -