Anticoagulation &  Atrial Fibrillation in CKD - VALKYRIE - Prof. de Vriese (Bruges)

Prof. An de Vriese explains the Pro's and Con's of oral anticoagulation in patients with chronic kidney diease (CKD) who have atrial fibrillation. Additionally, she discusses the choice between vitamin K antagonists (VKA) and Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) for those CKD patients who are selected for oral anticoagulation. Prof. de Vriese has initiated VALKYRIE, the only randomised and fully published study (as of April 2022) that has compared VKA and NOAC in dialysis patients. The interview was recorded on February 9th, 2022. Moderators: Prof. Dr. Dr. Stephan Schirmer (Kaiserslautern / Homburg, Germany), Priv.-Doz. Dr. Marlies Antlanger (Linz, Austria) and Prof. Dr. Gunnar Heine (Frankfurt / Homburg, Germany). Articles discussed: De Vriese AS, Caluwé R, Van Der Meersch H, De Boeck K, De Bacquer D. Safety and Efficacy of Vitamin K Antagonists versus Rivaroxaban in Hemodialysis Patients with Atrial Fibrillation: A Multicenter Randomized Controlled Trial. J Am Soc Nephrol. 2021 doi: 10.1681/ASN.2020111566 De Vriese AS, Caluwé R, Pyfferoen L, De Bacquer D, De Boeck K, Delanote J, De Surgeloose D, Van Hoenacker P, Van Vlem B, Verbeke F. Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with Atrial Fibrillation: the Valkyrie Study. J Am Soc Nephrol. 2020 doi: 10.1681/ASN.2019060579. Roy-Chaudhury P, Tumlin JA, Koplan BA, Costea AI, Kher V, Williamson D, Pokhariyal S, Charytan DM; MiD investigators and committees. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle. Kidney Int. 2018 doi: 10.1016/j.kint.2017.11.019 Van Der Meersch H, De Bacquer D, De Vriese AS. Vitamin K antagonists for stroke prevention in hemodialysis patients with atrial fibrillation: A systematic review and meta-analysis. Am Heart J. 2017 doi: 10.1016/j.ahj.2016.09.016. De Vriese AS, Heine G. Anticoagulation Management In Hemodialysis Patients With Atrial Fibrillation: Evidence And Opinion. Nephrol Dial Transplant. 2021 doi: 10.1093/ndt/gfab060 Turakhia MP, Blankestijn PJ, Carrero JJ, Clase CM, Deo R, Herzog CA, Kasner SE, Passman RS, Pecoits-Filho R, Reinecke H, Shroff GR, Zareba W, Cheung M, Wheeler DC, Winkelmayer WC, Wanner C; Conference Participants. Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Eur Heart J. 2018 Jun 21;39(24):2314-2325 Wizemann V, Tong L, Satayathum S, Disney A, Akiba T, Fissell RB, Kerr PG, Young EW, Robinson BM. Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy. Kidney Int. 2010 doi: 10.1038/ki.2009.477 De Vriese AS, Caluwé R, Bailleul E, De Bacquer D, Borrey D, Van Vlem B, Vandecasteele SJ, Emmerechts J. Dose-finding study of rivaroxaban in hemodialysis patients. Am J Kidney Dis. 2015 doi: 10.1053/j.ajkd.2015.01.022 Okumura K, Akao M, Yoshida T, Kawata M, Okazaki O, Akashi S, Eshima K, Tanizawa K, Fukuzawa M, Hayashi T, Akishita M, Lip GYH, Yamashita T; ELDERCARE-AF Committees and Investigators. Low-Dose Edoxaban in Very Elderly Patients with Atrial Fibrillation. N Engl J Med. 2020 doi: 10.1056/NEJMoa2012883 Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 doi: 10.1093/eurheartj/ehaa612. Chan KE, Edelman ER, Wenger JB, Thadhani RI, Maddux FW. Dabigatran and rivaroxaban use in atrial fibrillation patients on hemodialysis. Circulation. 2015 doi: 10.1161/CIRCULATIONAHA.114.014113. Su X, Yan B, Wang L, Lv J, Cheng H, Chen Y. Oral Anticoagulant Agents in Patients With Atrial Fibrillation and CKD: A Systematic Review and Pairwise Network Meta-analysis. Am J Kidney Dis. 2021 doi: 10.1053/j.ajkd.2021.02.328. Potpara TS, Ferro C, Lip GYH, Dan GA, Lenarczyk R, Mallamaci F, Ortiz A, Sarafidis P, Ekart R, Dagres N. Management of atrial fibrillation in patients with chronic kidney disease in clinical practice: a joint European Heart Rhythm Association (EHRA) and European Renal Association/European Dialysis and Transplantation Association (ERA/EDTA) physician-based survey. Europace. 2020 doi: 10.1093/europace/euz358.