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January 8, 2026The Korean Journal of Internal MedicineOpen Access

Comparative efficacy and safety of warfarin and direct oral anticoagulants in patients with end-stage renal disease and atrial fibrillation

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Key result

Both warfarin and DOACs reduce the risk of ischemic stroke/systemic embolism in patients with end-stage kidney disease and atrial fibrillation compared to no anticoagulation, but increased major bleeding risk.

Authors

YYYujin YangSLSun Hwa LeeWHWonmook Hwang

Discussion

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Overview

A multicenter retrospective study compares anticoagulant efficacy and safety in patients with end-stage renal disease and atrial fibrillation, suggesting DOACs may be preferable.

Key Points

  • This study evaluates the efficacy and safety of warfarin and direct oral anticoagulants in patients with end-stage renal disease and atrial fibrillation.
  • Multicenter retrospective study conducted with 933 patients from 2010 to 2023.
  • Participants grouped by initial treatment: no anticoagulation, warfarin, or DOACs.
  • Primary outcomes include ischemic stroke/systemic embolism and major bleeding; secondary outcomes include intracranial and gastrointestinal bleeding.
  • Warfarin and DOACs significantly reduced the risk of ischemic stroke/systemic embolism compared to no anticoagulation.
  • Warfarin increased the risk of major bleeding compared to no anticoagulation, while DOACs also increased this risk but less so than warfarin.
  • Both warfarin and DOACs reduced all-cause mortality relative to no anticoagulation.

Study Design

Type

Cohort (n=933)

Multicenter

Yes

PICO

P
Population
end-stage kidney disease and atrial fibrillation (n=933)
I
Intervention / Comparator
warfarin and direct oral anticoagulants (DOACs) vs no anticoagulation
O
Primary Outcome
ischemic stroke or systemic embolism (IS/SE) — aHR 0.55 (0.31-1.00), p=0.048

Main Result

Effect estimate: aHR 0.55 (95% CI 0.31-1.00)

Absolute Event Rate: 2.5% vs 4%

p-value: p=0.048

Limitations

  • Retrospective design may introduce confounding
  • Time in therapeutic range for warfarin not calculated
  • DOAC group included all four agents, limiting type-specific inferences
  • Subgroup analyses exploratory and not powered for definitive conclusions

Cite This Study

Yang et al. (2026) conducted a cohort in end-stage kidney disease and atrial fibrillation (n=933). warfarin and direct oral anticoagulants (DOACs) vs. no anticoagulation was evaluated on ischemic stroke or systemic embolism (IS/SE) (aHR 0.55, 95% CI 0.31-1.00, p=0.048). Both warfarin and DOACs reduce the risk of ischemic stroke/systemic embolism in patients with end-stage kidney disease and atrial fibrillation compared to no anticoagulation, but increased major bleeding risk.

synapsesocial.com/papers/69608779fa51ca23bb9809afhttps://doi.org/10.3904/kjim.2025.052
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