Background and Objectives: Although the need for anticoagulation to prevent
thromboembolism is increasing and non-
vitamin K antagonist oral
anticoagulants (NOACs) have been tried, there is still controversy about the efficacy of anticoagulation in patients with dialysis. Materials and Methods: We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with
atrial fibrillation (AF). We retrospectively analyzed all data of 89 patients who received dialysis
therapy and were diagnosed with AF. Among them, 27 received anticoagulation (11
warfarin and 16
apixaban 2.5 mg twice a day), while 62 received no anticoagulation. Results: In multivariate Cox regression analysis, compared to no anticoagulation treatment, anticoagulation treatment was associated with a low incidence of all-cause mortality (hazard ratios (HR) 0.36; 95% confidence interval (CI) 0.15-0.88). Compared to no anticoagulation treatment, more anticoagulation treatment patients experienced severe
bleeding (HR 4.67; 95% CI 1.26-17.25) and any
bleeding (HR 2.79; 95% CI 1.01-7.74). Compared to no anticoagulation,
warfarin treatment patients were associated with a low incidence of all-cause mortality (HR 0.26; 95% CI 0.09-0.81) and a high incidence of severe
bleeding (HR 4.85; 95% CI 1.12-21.10). All-cause mortality and
bleeding were not significantly different between no anticoagulation and
apixaban treatment patients. Conclusions: In dialysis patients with AF, anticoagulation
therapy is associated with an increased incidence of severe
bleeding, but anticoagulation
therapy is associated with a low incidence of all-cause mortality. Individualized anticoagulation
therapy with careful
bleeding monitoring is needed in dialysis patients with AF.