| Popis: |
Atrial fibrillation (AF) is the most common cause of stroke, and is a frequent comorbidity in patients with ESKD, affecting as many as one in five (1). The prevalence is 20% and 14% in patients on hemodialysis (HD) and peritoneal dialysis (2), and increases with age from 6% in the 22–44 year age group, 25% between 65 and 74 years, and 33% in patients aged >74 years (3). CKD is associated with an increased risk of ischemic stroke in patients with AF, independent of traditional risk factors for stroke, even in patients who are not on dialysis (4,5). Compared with White patients, Black, Hispanic, and Asian patients with ESKD are more likely to experience stroke (13%, 15%, and 16% more, respectively), and this is related to low warfarin prescription fill (6). The risk of ischemic stroke is much higher than the risk of hemorrhagic stroke in patients with ESKD (21.1 vs. 4.7 per 1000 patient years [7]), and incident AF is associated with increased mortality in patients with ESKD (8). Therefore, oral anticoagulation plays a key role in the management of these patients. In this article, we propose that oral anticoagulants (OAC) are beneficial in patients with AF and ESKD, and examine the evidence supporting it. ESKD by itself is a prothrombotic state, even in the absence of AF. Patients with kidney disease have an increased level and/or activity of numerous proinflammatory and procoagulant factors, such as C-reactive protein, cystatin C, IL-6, fibrinogen, factor VII, VIII, IX–XII, TNF-α soluble receptor-1, intracellular adhesion molecule-1, vWf, plasminogen activator inhibitor-1, homocysteine, thromboplastin, and fibrinopeptide. There is also a decreased level of protein C, an anticoagulant (2,3). If AF and stroke are each more common in patients with kidney failure, and kidney failure itself is prothrombotic, it … |
