Abstract Body (Do not enter title and authors here): Background: Anticoagulation is the standard treatment for the majority of patients with atrial fibrillation (AF) to reduce the risk of stroke. Anticoagulation is also utilized in patients with end-stage renal disease (ESRD) on hemodialysis (HD) who have AF. Such patients are at high risk for bleeding and stroke. However, limited data is available regarding utility of anticoagulation in such patients. The goal of this project was to assess the efficacy of anticoagulation to reduce the risk of stroke for patients with ESRD on HD who developed new onset AF.
Methods: The national Veterans Affairs (VA) electronic health records were utilized to identify patients with ESRD on HD from 01/01/2000 to 01/01/2018. Those with AF prior to HD were excluded. In addition, those with stroke, mitral or aortic valve surgery prior to AF were excluded. Anticoagulants included warfarin, or apixaban, rivaroxaban, edoxaban and dabigatran, collectively termed DOACs. Patients were considered to be on an anticoagulation if they received anticoagulation for >1 month. All diagnoses were based on International Classification of Disease (ICD) 9^th and 10^th versions, and Current Procedural Terminology codes. Follow up period extended from the onset of AF to 01/01/2020 or death.
Results: Over the study period 12,559,292 patients visited any of the VAs nationally. Of these, 89,081 were on HD without prior AF. Of those, 17,192 (19.3%) developed new AF. Of these 13,649 had no stroke, mitral or aortic surgery prior to the AF diagnosis. Of the 9,227 patients in the no anticoagulation cohort, 476 patient subsequently had stroke (5.16%). Of the 3,708 warfarin treated patients, 533 had subsequent stroke (14.37). Of the 358 DOAC patients, 34 (9.95%) had subsequent stroke. The difference in the stroke rates between those anticoagulated and those not anticoagulated was significant (P<0.01).
Conclusions: These preliminary data reveal significant differences in the rate of stroke based on anticoagulation status, and potentially specific type of anticoagulation in HD patients with new onset AF. Further studies are indicated to assess both the safety and efficacy of anticoagulation in HD patients with new onset AF.