Anti-coagulation, anti-platelets or no therapy in haemodialysis patients with atrial fibrillation: A decision analysis

Melanie L.R. Wyld, Philip A. Clayton, Rachael L. Morton, Steven J. Chadban

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Optimal treatment of atrial fibrillation (AF) in the haemodialysis population is uncertain due to the exclusion of this group from randomized trials. The risk-benefit profile for anticoagulation and anti-platelet therapy in haemodialysis differs from the general population due to platelet dysfunction from uraemia, altered pharmacokinetics and increased falls risk. Methods: This decision analysis used a Markov-state transition model that took a patient perspective over a 5 year timeframe. The Markov model compared life-years gained and quality-adjusted life-years gained (QALY) for three AF treatment strategies: warfarin, aspirin and no treatment. The base case was a 70-year-old man on haemodialysis with non-valvular AF. Results: In the base case, the total health outcomes in life-years and QALY were 2.37 and 1.47 respectively for warfarin, 2.38 and 1.61 respectively for aspirin, and 2.39 and 1.61 respectively for no treatment. Thus, warfarin led to 0.14 fewer QALY or 1.7 fewer months of life lived in full health, compared with either aspirin or no therapy. The finding that warfarin generated the lowest expected QALY was robust to one-way, two-way and probabilistic sensitivity analyses. Conclusions: Our results suggest that warfarin should not be the default choice for older haemodialysis patients with non-valvular AF as it provides the fewest QALY compared with aspirin or no therapy.

LanguageEnglish
Pages783-789
Number of pages7
JournalNephrology
Volume18
Issue number12
DOIs
Publication statusPublished - 1 Jan 2013
Externally publishedYes

Keywords

  • Markov chain
  • atrial fibrillation
  • dialysis
  • quality-adjusted life-year
  • warfarin

ASJC Scopus subject areas

  • Nephrology

Cite this

Wyld, Melanie L.R. ; Clayton, Philip A. ; Morton, Rachael L. ; Chadban, Steven J. / Anti-coagulation, anti-platelets or no therapy in haemodialysis patients with atrial fibrillation : A decision analysis. In: Nephrology. 2013 ; Vol. 18, No. 12. pp. 783-789.
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Anti-coagulation, anti-platelets or no therapy in haemodialysis patients with atrial fibrillation : A decision analysis. / Wyld, Melanie L.R.; Clayton, Philip A.; Morton, Rachael L.; Chadban, Steven J.

In: Nephrology, Vol. 18, No. 12, 01.01.2013, p. 783-789.

Research output: Contribution to journalArticle

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