Warfarin use in patients with both end-stage renal disease (ESRD) and atrial fibrillation are at increased risk for stroke, data suggest. It is not associated with increased all-cause mortality or hospitalization.

Researchers followed 1,671 new ESRD patients with preexisting atrial fibrillation for an average of 1.6 years from the time they started dialysis. Compared with nonuse, warfarin use was associated with a nearly twofold increased risk for a new stroke, investigators reported in the Journal of the American Society of Nephrology (2009;20:2223-2233). Clopidogrel or aspirin use was not associated with the risk of a new stroke.

The investigators concluded that “physicians should be cognizant of the possible risks associated with warfarin use for atrial fibrillation in patients with ESRD, with careful evaluation of the risks and benefits of intervention at the individual patient level.”