Warfarin in haemodialysis patients with atrial fibrillation: what benefit?
Europace. 2010 Dec;12(12):1666-72. Epub 2010 Nov 2. PMID: 21045011
Division of Cardiology/Arrhythmia Offices Forman 2, Department of Medicine, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA. firstname.lastname@example.org
Warfarin is commonly used to prevent stroke in patients with atrial fibrillation; however, patients on haemodialysis may not derive the same benefit from warfarin as the general population. There are no randomized controlled studies in dialysis patients which demonstrate the efficacy of warfarin in preventing stroke. In fact, warfarin places the dialysis patient at increased risk for haemorrhagic stroke and possibly ischaemic stroke. Additionally, warfarin increases the risk of major bleeding and has been associated with vascular calcification. Routine use of warfarin in dialysis for stroke prevention should be discouraged, and therapy should only be reserved for dialysis patients at high risk for thrombo-embolic stroke and carefully monitored if implemented.