Additional research is needed to determine why warfain has the opposite effect on stroke risk in kidney disease patients on dialysis compared with other individuals. One possible explanation maybe because bleeding is a well known complication of kidney failure and the concomitant use of blood thinners may exaggerate the risk of stroke from bleeding in the head. Also, this study's findings should be validated through randomized controlled clinical trials. "Until then, physicians should be cognizant of the possible risks associated with warfarin use for atrial fibrillation in ESRD patients with careful evaluation of the risks and benefits of intervention at the individual patient level," they concluded.

Drs. Chan, Lazarus, and Hakim are employees of Fresenius Medical Care North America.

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