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. Studies suggest that the CHA2DS2-VASc score can adequately risk stratify for ischemic stroke among a hemodialysis population, but there are virtually no randomized trial data of oral anticoagulation in severe CKD (creatinine clearance [CrCl] < 25-30 mL/min). Moderate to severe CKD increases the risk of major and intracranial bleeding through a number of mechanisms, and the risk may be further increased by the use of oral anticoagulation or APT.