IMR Press / FBS / Volume 14 / Issue 3 / DOI: 10.31083/j.fbs1403021
Open Access Review
Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse
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1 Internal Medicine Department, Konstantopoulio General Hospital, 14233 Athens, Attica Province, Greece
2 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Attica Province, Greece
3 Nephrology Department & Attikon University Hospital, National & Kapodistrian University of Athens, 12462 Athens, Attica Province, Greece
4 Second Department of Cardiology, University General Hospital, “Attikon”, Athens, National and Kapodistrian University of Athens, 11527 Athens, Attica Province, Greece
*Correspondence: (Marios Sagris)
Academic Editor: Neven Zarkovic
Front. Biosci. (Schol Ed) 2022, 14(3), 21;
Submitted: 15 March 2022 | Revised: 7 April 2022 | Accepted: 13 April 2022 | Published: 21 July 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

The most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease (ESKD). On the other hand, direct OACs (DOACs) are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio (INR) monitoring. For those patients, warfarin and apixaban appear to be FDA-approved, whereas dabigatran, rivaroxaban, and edoxaban are not recommended yet. Due to a lack of large randomized studies, data from major trials cannot be extended to dialysis patients. In this review, we summarize the available data and literature referring to patients on chronic hemodialysis with concomitant AF. Due to the scarcity of data, we try to assist clinicians in selecting the appropriate therapy according to the specific characteristics of each patient. Finally, future directions are provided in two key areas of focus: left atrial appendage closure therapies and genetic research.

atrial fibrillation
chronic kidney disease
optimal management
future directions
Fig. 1.
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