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Management of anticoagulation in hemodialysis: Results from a survey of current clinical practice in the Italian anticoagulation clinics

      Patients with end stage renal disease (ESRD) on maintenance hemodialysis (HD) have a high risk for both thromboembolic and hemorrhagic complications [
      • Friberg L.
      • Benson L.
      • Lip G.Y.H.
      Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: the swedish atrial fibrillation cohort study.
      ]. Thromboembolic risk is related to an increased level of some procoagulant factors, such as Factor (F)VIII and von Willebrand factor, hyperhomocysteinemia and dyslipidemia. Hemorrhagic risk is mostly due to a platelets' dysfunction, particularly in the adhesion and aggregation phases [
      • Sohal A.S.
      • Gangji A.S.
      • Crowther M.A.
      • Treleaven D.
      Uremic bleeding: pathophysiology and clinical risk factors.
      ]. Furthermore, the advanced age and comorbidities of HD patients (i.e. arterial hypertension, congestive heart failure) further increase the risk of both thromboembolic and hemorrhagic events and justify the higher prevalence of atrial fibrillation (AF) compared to a non-HD population [
      • Zimmerman D.
      • Sood M.M.
      • Rigatto C.
      • et al.
      Systematic review and metaanalysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis.
      ].

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