Increased risk of bleeding in patients with atrial fibrillation and chronic kidney disease on hemodialysis treated with anticoagulants. A four center serie




Laura V. López-Gutiérrez, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Colombia
María I. Mora-Atehortúa, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
Sebastián Peláez-García, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
Fabián A. Jaimes-Barragán, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
Yesid A. Saavedra-González, Servicio de Cardiología, Hospital Pablo Tobón Uribe, Colombia
Diego A. Ossa-Estrada, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
Juan P. Villegas-Molina, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
Andrés H. Polo-Guzmán, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
Clara I. Saldarriaga-Giraldo, Servicio de Cardiología, Clínica CardioVID, Universidad de Antioquia. Antioquia, Colombia


Background: Because the benefits and risks of anticoagulation are still unknown in patients with atrial fibrillation (AF) and with chronic kidney disease (CKD) on hemodialysis. Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS- 2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.



Keywords: Atrial fibrillation. Chronic kidney disease. Hemodialysis. Kidney dialysis. Thrombosis. Anticoagulant.