Danison Emmerson: A New Chapter in Stroke Prevention for Dialysis Patients
Danison Emmerson, Vascular neurologist, UMass Memorial Medical Center, shared a post on LinkedIn:
“A New Chapter in Stroke Prevention for Dialysis Patients: Closing the Gap, Literally
A recent JAMA Network Open study by Dhar et al. (2025) offers encouraging data on left atrial appendage closure (LAAC) in patients with atrial fibrillation on dialysis — a group notoriously difficult to manage for stroke prevention.
Read the study
As a Vascular neurologist, I find this especially relevant. In dialysis patients, effective anticoagulation is often more aspirational than achievable — complicated by uremic platelet dysfunction, shifting pharmacokinetics, and procedural interruptions. Even with close monitoring, we rarely know if patients are truly protected or just trading one risk for another.
That’s why I view LAAC as a favorable alternative to lifelong oral anticoagulation in this population. The study found:
- Lower bleeding risk compared with oral anticoagulants
- Reduced all-cause mortality
- No significant increase in stroke events
This mechanical solution may offer the most stable path to stroke prevention in patients for whom consistent anticoagulation is clinically elusive. From a systems perspective, it also aligns with precision medicine — tailoring prevention to physiology, not protocol.
Randomized data (such as the upcoming LAA-KIDNEY trial) will be critical, but this represents a meaningful step toward rethinking how we protect some of our most complex patients from devastating cerebrovascular events.
“In dialysis-associated atrial fibrillation, achieving therapeutic anticoagulation isn’t just challenging — it’s uncertain. LAAC may finally close that gap.”
References:
Dhar R, Sandhu GS, et al. JAMA Netw Open. 2025;8(10):e2838656
Genovesi S, Camm AJ. JAMA Netw Open. 2025;8(10):e2838656
Siontis KC et al. Circulation. 2018;138:1519–1529
Holmes DR Jr et al. JACC. 2019;74:287–297″
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