Safe Prescribing on Dialysis: Latest update on Directly-acting Oral Anticoagulants

The evidence for the use of Directly-acting Oral Anticoagulants (DOACs) to prevent stroke in patients with non-valvular AF is compelling for patients with normal and modestly impaired renal function. Patients with more advanced Chronic Kidney Disease and treated with Dialysis have a high prevalence of AF and risk factors for stroke based on conventional measures. They have unconventional vascular disease.

Until very recently the evidence base for patients with CKD4/5 and Dialysis has remained confined to cohort observational studies which are confounded. Prescribing practice for anticoagulants is inferred rather than proven and carries risk.

There is new hope!

Notably since 2021, there have been the first ever randomised control trials published in Haemodialysis. Similar trials have not been done in Peritoneal Dialysis.

We will learn: 1] The existing evidence for anticoagulant treatment 2] The benefit and harm from treatment 3] What DOACs add

This is an opportunity for delegates of the Dialysis Academy to re-examine their anticoagulant practice where the risk of bleeding is substantial and the benefits uncertain