Net Effect of Warfarin for Patients with Atrial Fibrillation and Chronic Kidney Disease

Atrial fibrillation (AF) and chronic kidney disease (CKD) coexist commonly. However, randomized trials of anticoagulation for AF have excluded patients with severe CKD, and observational studies of the efficacy and safety of anticoagulation in AF patients with CKD have yielded varying results. Now, researchers have conducted a meta-analysis of 11 cohort studies in which investigators examined effects of warfarin in such patients.

In AF patients with non–end-stage CKD, warfarin was associated with lower risk for ischemic stroke or thromboembolism (hazard ratio, 0.70), lower mortality (HR, 0.65), and no excess major bleeding risk, compared with no anticoagulation. In patients with end-stage CKD (i.e., patients receiving renal replacement thera…