Aymeric Couturier Shares Recent Studies on Anticoagulation and Atrial Fibrillation in Dialysis
Aymeric Couturier, Nephrologist at American Hospital;Necker Hospital, shared on LinkedIn:
”Anticoagulation and atrial fibrillation in dialysis: a paradigm shift on the horizon
Recent data show that the net benefit of oral anticoagulation remains uncertain in this high-risk population.
• An editorial by An S. De Vriese (JASN, 2025) calls for a reconsideration of our practices: caution with VKAs, possible use of appropriate DOACs, and openness to non-pharmacological strategies (atrial occlusion).
• The SAFE-D pilot trial (JASN, 2025) comparing warfarin, apixaban, and no anticoagulation in 151 dialysis patients with AF demonstrates the feasibility of a large-scale trial, but above all highlights the lack of clear benefit at this stage.
Three randomized trials already published — VALKYRIE (rivaroxaban vs. warfarin, n=132), RENAL-AF (apixaban vs. warfarin, n=154) and AXADIA-AFNET 8 (apixaban vs. warfarin, n=97)—show, despite their small sample sizes, a trend favoring DOACs over VKAs.
Three ongoing trials, this time with large sample sizes (718 to 1,500 patients), finally include a non-anticoagulation arm:
• DANWARD (warfarin vs. no anticoagulation, n=718)
• SACK (apixaban vs. no anticoagulation, n=1,400)
• VISIONAIRE (edoxaban vs. warfarin vs. no anticoagulation, n=1,500)
The time has come for an individualized approach, incorporating informed patient choice, therapeutic alternatives, and shared decision-making.”
Read the full article in JASN.
Article 1: Anticoagulation for Atrial Fibrillation in Kidney Failure. A Call to Arms
Authors: De Vriese, An S.
Read the full article in JASN.
Article 2: Anticoagulation for Patients with Atrial Fibrillation Receiving Dialysis. A Pilot Randomized Controlled Trial
Authors: Harel Ziv, Smyth Brendan, Badve Sunil V., Blum Daniel, Beaubien-Souligny William, Silver Samuel A., Clark Edward, Suri Rita, Mavrakanas Thomas A., Sasal Joanna, Prasad Bhanu, Eikelboom John, Tennankore Karthik, Rigatto Claudio, Prce Ivana, Madore Francois, Mac-Way Fabrice, Steele Andrew, Zeng Yangmin, Sholzberg Michelle, Dorian Paul, Yan Andrew T., Sood Manish M., Gladstone David J., Tseng Eric, Kitchlu Abhijat, Walsh Michael, Sapir Danny, Oliver Matthew J., Krishnan Murali, Kiaii Mercedeh, Wong Nikki, Kotwal Sradha, Battistella Marisa, Acedillo Rey, Lok Charmaine, Weir Matthew, Wald Ron
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