Current Situation And Prognosis Of Anticoagulation In Patients With Atrial Fibrillation And Chronic End-stage Renal Disease

Objective:To retrospectively analyze the current status of anticoagulant therapy in patients with atrial fibrillation complicated with chronic end-stage nephropathy(end-stage renal disease)and analyze the anticoagulant status of these patients in other regions of the world.To provide reference information for clinical practice.Methods:1.Collected the medical records of patients with atrial fibrillation complicated with chronic end-stage renal disease who were hospitalized in our hospital in January 2011 and May 2018,and analyzed the use of anticoagulants,embolization,hemorrhage,all-cause death and influencing factors.2.Search was conducted independently by two researchers.The online retrieval scope includes databases such as PubMed,Embase and Cochrane library,and the retrieval time is up to May 01,2018.There are no language and publishing restrictions on retrieval.At the same time,the two researchers manually searched the references and guidelines of related articles to obtain more relevant literatures.Results:1.93 patients with atrial fibrillation and end-stage renal disease were included in the retrospective analysis,with an average age of 69.51±12.89,57%male,and an average follow-up time of 2.47±1.59 years.The risk of all-cause death was high,especially when the heart function was ?-?.However,elderly patients(?75 years old)have a higher risk of ischemic stroke,which may be increased when combined with hypertension,coronary heart disease and previous history of embolism.Men account for 57%of the elderly,coronary heart disease,hypertension,diabetes and smoking population.2.17.2%of the patients used anticoagulation therapy;Anticoagulant therapy does not benefit the prevention of ischemic stroke and does not increase the risk of bleeding,but in the case of non-anticoagulation,the risk of all-cause death may increase.The probability of using anticoagulant therapy in diabetes mellitus is increased,while the proportion of anticoagulant therapy in elderly patients and hypertension is decreased.3.When CHA 2D2-VASC score?4 points and HAD-BLES score?3 points,anticoagulant therapy can reduce the risk of all-cause death,but may increase the risk of bleeding.4.In the meta-analysis,14 reports were studied,including 27,919 cases of patients with atrial fibrillation combined with end-stage renal disease,and 13 studies reported the risk of stroke.13 reported risk of bleeding;Eleven reported deaths.Seven cohort studies were from the americas(USA,Canada),four from Asia(Korea,Japan),two from Europe(Italy)and one from Australia[24].The Asian population accounted for 20.68%of the study participants.All studies were selected by men and women.Anticoagulant therapy did not benefit from the prevention of ischemic stroke(P = 0.055).In terms of absolute risk,although it can reduce the risk of all-cause death by 7.6%(P = 0.026),the risk of bleeding increased by 26%(P = 0.000).Conclusion:1.Patients with atrial fibrillation and end-stage renal disease have a higher risk of all-cause death,older patients are more likely to have ischemic stroke,and men have a higher risk of embolism than women.Anticoagulant therapy does not benefit from the prevention of ischemic stroke.Although it can reduce the risk of all-cause death,there is still a high risk of bleeding.2.Hemodialysis patients with atrial fibrillation are less likely to use anticoagulant therapy in clinical practice.Due to the potential risk of bleeding,warfarin is not recommended as a treatment strategy for stroke prevention.Clinical physicians must conduct in-depth discussions on potential risks and benefits for individualized treatment.3.It is suggested that the CHA 2D S2-VASC score for initiating anticoagulation should be increased.In a comprehensive assessment of the bleeding risk of patients,anticoagulation treatment may benefit patients by reducing the risk of all-cause death.