What is the net clinical benefit of oral anticoagulation in severe Chronic Kidney Disease (CKD)?
The net clinical benefit of oral anticoagulation in severe Chronic Kidney Disease (CKD) is still controversial. Observational studies suggest that warfarin may be harmful in end-stage renal disease patients on hemodialysis, with no reduction (or an increase) in stroke and an excess of major bleeding. However, European data suggest that there is a beneficial reduction in ischemic stroke which outweighs the increase in severe bleeding, where TTR is good (> 65%-70%). The latest systematic review and meta-analysis by Harel of 14 observational studies found that the use of warfarin was not associated with ischemic stroke or ICH (hemorrhagic stroke). Therefore, further research is needed to determine the net clinical benefit of oral anticoagulation in severe CKD.