The prevention of atrial fibrillation related thromboembolism in the dialysis population is unclear. While the practice of anticoagulation appears favorable in patients with mild-to-moderate chronic kidney disease, no patients with severe chronic kidney disease (estimated glomerular filtration rate \<25 ml/min), and specifically those receiving dialysis, have been included in randomized trials.Moreover, the effect of anticoagulation in the dialysis population may fundamentally differ from those studied in clinical trials. Accordingly, characterization of the optimal management strategy to reduce the risk of stroke and systemic embolism in patients with atrial fibrillation receiving dialysis is a priority. The overall goal of this pilot trial is to evaluate the feasibility of conducting a randomized controlled trial comparing anticoagulation strategies in patients with atrial fibrillation receiving dialysis (either hemodialysis or peritoneal dialysis).
Who can participate
Age range18 Years
SexALL
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Inclusion criteria
✓. Age ≥ 18 years.
✓. Receiving maintenance hemodialysis or peritoneal dialysis for \> 90 days.
✓. History of AF or atrial flutter as defined by:
✓. Satisfying CHADS-65 criteria: i) Age ≥65 or ii) Age \<65 and one of: hypertension, diabetes mellitus, congestive heart failure, stroke/transient ischemic attack or peripheral embolism.
Exclusion criteria
✕. Moderate or severe mitral stenosis.
✕. Conditions other than non-valvular atrial fibrillation that require oral anticoagulation, such as mechanical prosthetic valve, deep venous thrombosis, or pulmonary embolism.
✕. Need for aspirin at a dose \> 165 mg a day, or need for aspirin in combination with P2Y12 antagonist therapy.
✕. Need for an interacting drug which precludes the safe use of apixaban.
✕. Life expectancy \< 6 months.
What they're measuring
1
Recruitment of the target population within 2 years
Timeframe: 2 years from start of trial
2
At least 80% of randomized participants remain in the trial and on the allocated study treatment at the end of the 26-week study period.
. Scheduled live-donor kidney transplant in the next 6 months.
✕. A woman who is pregnant or breastfeeding or unwilling to pursue methods of contraception if \< 12 months since the last menstrual period.
✕. Co-enrollment in a clinical trial where the intervention is deemed to interfere with the adherence, safety or efficacy of the intervention provided herein.