Key result
Warfarin use in patients with atrial fibrillation and end-stage renal disease increases the risk of hemorrhagic stroke and vascular calcification, with unclear utility in reducing ischemic stroke.
Why the study?
Does anticoagulant therapy (warfarin) reduce ischemic stroke or increase bleeding in patients with atrial fibrillation and end-stage renal disease?
Does anticoagulant therapy (warfarin) reduce ischemic stroke or increase bleeding in patients with atrial fibrillation and end-stage renal disease?
In patients with AF and ESRD, warfarin increases bleeding and hemorrhagic stroke risk with unclear benefits for ischemic stroke prevention, highlighting the need for randomized trials.
May warrant avoiding routine warfarin in AF with ESRD due to bleeding risk; leaves open net benefit pending RCTs.
Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with an increased risk for thromboembolic stroke. Anticoagulant therapy has been shown to reduce the risk for ischemic stroke in patients with AF; however, these studies have excluded patients with end-stage renal disease (ESRD). This review examines the relationships between ESRD, AF, and the use of anticoagulants to prevent ischemic stroke. Medline and Embase were used to identify relevant articles. Identified review articles and their references were searched. The prevalence of AF in patients with ESRD is higher than that in the general population; ESRD appears to be an independent risk factor for AF. The presence of AF in patients with ESRD increases the risk for stroke, although this effect is less pronounced when compared with the general population. The presence of ESRD confers an increased risk for bleeding; warfarin appears to enhance this risk. Observational data suggest that warfarin increases the rate of hemorrhagic stroke in patients with ESRD, but are unclear on its utility in reducing ischemic stroke. In addition to increasing the risk for bleeding, warfarin may also promote vascular calcification in this population. Currently, there are no oral anticoagulants other than warfarin that are approved for use in patients with ESRD. Recent guidelines suggest that warfarin only be used for secondary prevention in patients with ESRD and AF. Randomized controlled trials are needed to clarify the role of warfarin or other anticoagulants in preventing stroke in patients with ESRD and AF.
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Brimble et al. (2012) conducted a review in Atrial Fibrillation and End-Stage Renal Disease. Warfarin was evaluated. Warfarin use in patients with atrial fibrillation and end-stage renal disease increases the risk of hemorrhagic stroke and vascular calcification, with unclear utility in reducing ischemic stroke.
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