Anticoagulation for AF in Patients with Renal Disease: Between a Rock and a Hard Place

Both renal insufficiency and atrial fibrillation (AF) increase the risk for stroke, yet patients with renal disease are largely excluded from trials of anticoagulation therapy for AF. Investigators culled data from several Danish national registries to assess the risk for stroke in 132,372 patients with AF stratified by treatment with warfarin, aspirin, both, or neither. Of this cohort, 3587 patients (2.7%) had non–end-stage renal disease, and 901 (0.7%) required renal replacement therapy (largely hemodialysis, but also renal transplantation).

The risk for stroke was significantly higher in patients with renal disease than in those without it (hazard ratios, 1.49 and 1.83 for non–end-stage and end-stage renal disease, respectively). In patie…