Anticoagulation Management in haemodialysis patients with atrial fibrillation - The Missing Link


The missing link in the debate on OAC in dialysis patients is appropriate risk stratification. The CHA2DS2-VASc score is widely employed to stratify the risk of ischaemic stroke in patients with AF, superseding the previously used CHADS2 score because of its better discriminative value. OAC is officially recommended when patients with AF have CHA2DS2-VASc scores ≥2 for men and ≥3 for women [2]. When this criterion is applied to the HD population with AF, nearly all patients qualify for OAC. However, the incidence of stroke appears to be lower in HD patients with AF than in non-dialysis patients with similar CHA2DS2-VASc scores [30], implying that the CHA2DS2-VASc score overestimates stroke risk in dialysis patients. In addition, the high risk of mortality due to bleeding may outweigh the stroke risk in a substantial proportion of dialysis patients with AF.