#1857 The efficacy and safety of using various combinations of antithrombotic therapy in patients with AF and ESKD undergoing program hemodialysis

Abstract Background and Aims The problem of tactics of management of patients with atrial fibrillation (AF) and end-stage kidney disease (ESKD) undergoing program hemodialysis is one of the most poorly studied and unresolved. One of the main problems still remains the choice of correct antithrombotic therapy. The aim is to study the efficacy and safety of using various combinations of antithrombotic therapy in patients with AF and ESKD on hemodialysis. Method Participants in study were 86 patients with AF and ESKD, requiring hemodialysis: group 1 patients received combination therapy (warfarin and aspirin (75 mg), n = 38)) and group 2 received warfarin monotherapy (n = 48). The warfarin dose was adjusted according to international normalised ratio data and maintained in the target therapeutic range of 2.0–3.0. Results In terms of prevention of thromboembolic complications, therapy in both groups of patients demonstrated statistically insignificant results. In the combination therapy group, the hazard ratio (HR) for ischemic stroke was 0.75 (95% CI: 0.08–1.66), and for myocardial infarction, the HR was 0.79 (95% CI: 0.70–1.31). Among patients receiving monotherapy, these indicators were HR 0.80 (95% CI: 0.44–1.70) and HR 0.84 (95% CI: 0.55–0.92). However, during the observation period, bleeding was more often recorded in the combination therapy group (21% of cases) compared to the monotherapy group (8% of cases, P = 0.02). In the combination therapy group, major and clinically significant bleeding occurred twice as often (HR 2.59 (95% CI: 1.46–4.69) and HR 2.37 (95% CI: 1.49–6.16)) than in the warfarin monotherapy group (HR 1.17 (95% CI: 0.95–3.15) and HR 1.34 (95% CI: 1.14–2.84)). The number of minor bleeding events was almost the same in both groups. Conclusion Antithrombotic therapy in the form of warfarin and warfarin+aspirin combination did not show the expected results in preventing thromboembolic and hemorrhagic complications in patients with AF and ESKD, who received hemodialysis. In particular, combination therapy dramatically increased the incidence of life-threatening bleeding.