End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA2DS2-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

中文翻译：

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终末期肾病和心房颤动患者的抗凝治疗：困惑、担忧和后果。


终末期肾病（ESRD）患者糖尿病、高血压、充血性心力衰竭和高龄的患病率较高，非瓣膜性心房颤动（AF）的发病率也较高，从而增加了脑血管意外的风险。因此，建议患有 AF 的 ESRD 患者进行全身抗凝，以降低血栓栓塞的风险和并发症。矛盾的是，由于严重的血小板功能障碍以及血小板与内皮之间的相互作用受损，这些患者的出血风险增加。目前，CHA2DS2-VASc和高血压、肝肾功能异常、中风、出血、INR不稳定、老年人、药物或酒精（HAS-BLED）是AF患者中风风险分层和出血风险评估的推荐模型。关于抗血小板药物、华法林和直接口服抗凝药等药物对患有 AF 的 ESRD 患者的益处和风险，存在相互矛盾的数据。此外，尚无随机对照试验数据来指导临床决策。因此，建议采用多学科方法，每年重新评估治疗目标和风险效益评估。在本文中，我们回顾了当前关于 ESRD 合并 AF 患者抗凝治疗的风险和益处的建议。