Kidney Week

Abstract: TH-PO0873

Anticoagulation Strategies in Patients on Haemodialysis with Nonvalvular Atrial Fibrillation: A Two-Centre Real-World Analysis

Session Information

• Dialysis: Prescription, Physiology, and Treatment Optimization
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Chafekar, Nahush Deodatta, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom

Nahush Deodatta Chafekar, MD, MBBS

• Subbarayan, Jeya Surya, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough, United Kingdom

Jeya Surya Subbarayan, MBBS

• Iyer, Jairam Sujjay, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, United Kingdom

Jairam Sujjay Iyer, MD, MBBS

• Kleemann, Frieder, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough, United Kingdom

Frieder Kleemann, MBChB

• Kamalanathan, Manivarma, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom

Manivarma Kamalanathan, MD, MBBS

Background

Anticoagulation for non-valvular atrial fibrillation (NVAF) in haemodialysis (HD) patients remains clinically uncertain. Current guidance reflects equipoise between vitamin K antagonists and reduced-dose apixaban, despite limited and conflicting evidence. Observational studies report increased bleeding and uncertain stroke reduction in HD patients receiving anticoagulation. We evaluated real-world thromboembolic and bleeding outcomes associated with anticoagulation strategies in HD patients with NVAF.

Methods

We performed a cross-sectional study of adult maintenance HD patients with established NVAF at two UK hospitals. Patients were grouped by anticoagulation strategy: warfarin, apixaban 2.5 mg BD, or no anticoagulation. Patients with mechanical valves, peritoneal dialysis, or prior kidney transplantation were excluded. Outcomes were retrospectively identified from electronic hospital and discharge records as lifetime events occurring after both NVAF and HD criteria were met. Outcomes included stroke, stroke/transient ischaemic attack (TIA), clinically relevant non-major (CRNM) bleeding, and major bleeding.

Results

60 HD patients with NVAF were included: warfarin (n=44), apixaban (n=7), and no anticoagulation (n=9). Groups were comparable for age, CHA2DS2-VASc, and HAS-BLED scores (all p>0.05). Stroke occurred in 9.1% (4/44) of warfarin-treated patients, with no strokes observed in the apixaban or no-anticoagulation groups. CRNM bleeding occurred more frequently with apixaban (57.1%, 4/7) compared with warfarin (20.5%, 9/44) and no anticoagulation (11.1%, 1/9), with borderline statistical significance versus warfarin (p=0.061). Major bleeding occurred in 28.6% of apixaban-treated patients, compared with 13.6% on warfarin and 11.1% without anticoagulation. Exploratory analyses suggested concomitant antiplatelet therapy was associated with higher thromboembolic and bleeding event rates.

Conclusion

In this HD cohort with NVAF, no anticoagulation had the most favourable observed balance between thromboembolic and bleeding outcomes. Apixaban showed a concerning signal for CRNM bleeding, while warfarin showed the highest observed stroke rate. Although limited by cross-sectionality, lifetime event ascertainment, and small subgroup sizes, these findings are hypothesis-generating and support cautious, individualised anticoagulation decisions in HD patients.