Strategies for the management of Atrial Fibrillation in patiEnts receiving HemoDialysis (SAFE-HD)

Atrial fibrillation, the most commonly diagnosed heart rhythm abnormality, is approximately 20 times more common in patients receiving dialysis than in those not receiving dialysis, and is associated with a higher-risk of stroke. In patients not receiving dialysis with atrial fibrillation, blood thinners are prescribed to decrease the risk of stroke. This however, comes at the cost of a potential increased risk of bleeding. In patients with atrial fibrillation receiving dialysis, there is much debate about using blood thinners as there are no studies to guide clinicians whether this treatment is beneficial, or even harmful. We propose a pilot trial to establish the feasibility of comparing the use of two blood thinners (warfarin and apixaban) versus no blood thinners (conservative care) in patients with atrial fibrillation receiving dialysis. This information will lay the groundwork for a large definitive trial that will determine whether the use of blood thinners or no blood thinners leads to a decreased risk of stroke among patients with atrial fibrillation receiving dialysis.