Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Introduction

Nonvalvular atrial fibrillation is the most common cardiac arrhythmia encountered in patients with ESRD; however, its optimal management is controversial, particularly with respect to the use of oral anticoagulation for the prevention of thromboembolic stroke. Although there is strong evidence for the use of oral anticoagulation with warfarin in patients with nonvalvular atrial fibrillation who do not have advanced kidney disease, its benefits are diminished and the risks of drug-induced bleeding are increased in patients with ESRD. In this Controversies in Nephrology, McCullough et al. provide the arguments for and Keskar and Sood provide the arguments against the use of oral anticoagulation in patients with dialysis-requiring ESRD. These are then followed by a trio of brief verdicts from Bansal, Herzog, and Rigatto, who provide their assessments of the strengths and weaknesses of the arguments by proponents for and those against the use of oral anticoagulation. The editors hope that this Controversies in Nephrology helps provide clarity to guide the management of our patients with ESRD and nonvalvular atrial fibrillation.