AF Anticoagulation in ESKD — RACP Adult Medicine MCQ

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HardCardiologyAF Anticoagulation in ESKDRACP Adult Medicine

A 75-year-old woman with AF (CHA₂DS₂-VASc 4) and CKD stage 5 (eGFR 12, on haemodialysis) has a HAS-BLED score of 3. She had a GI bleed 2 years ago (now resolved). What is the most appropriate anticoagulation decision?

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Correct answer: C — Apixaban 5 mg BD

AF anticoagulation in ESKD/dialysis is controversial. Warfarin in dialysis patients may increase vascular calcification risk. Apixaban 5 mg BD (not dose-reduced in dialysis — RENAL-AF trial and AXADIA-AFNET 8) is increasingly used. Rivaroxaban and edoxaban are NOT recommended in severe CKD/dialysis. Dabigatran is contraindicated (renally cleared). HAS-BLED ≥3 indicates modifiable bleeding risk factors should be addressed — it is NOT a reason to withhold anticoagulation.

Reference: CSANZ – 2024 – AF in CKD; KDIGO 2024; RENAL-AF Trial