What is the net clinical benefit of oral anticoagulation in severe CKD?
There is significant controversy as to the net clinical benefit of oral anticoagulation in severe CKD despite encouraging observational studies. Virtually no randomized trial data of oral anticoagulation in severe CKD (creatinine clearance [CrCl] < 25-30 mL/min) exists. Observational data from North America 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. In contrast, European data suggest there is a beneficial reduction in ischemic stroke which outweighs the increase in severe bleeding, where TTR is good (> 65%-70%). However, a systematic review and meta-analysis by Harel found that the use of warfarin was not associated with a clear benefit or harm among patients who have AF and receive dialysis.