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General medicine
Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrial fibrillation
  1. David Massicotte-Azarniouch1,
  2. Manish M Sood1,2,3
  1. 1 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  1. Correspondence to Dr Manish M Sood, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; msood{at}toh.on.ca

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Commentary on: Kumar S, de Lusignan S, McGovern A, et al. Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. BMJ. 2018:k342. doi:10.1136/bmj.k342

Context

In the general population anticoagulation for atrial fibrillation (AF) reduces the risk for stroke. However, there is a lack of randomised controlled trials of anticoagulation in patients with chronic kidney disease (CKD). This is problematic since with declining kidney function, individuals are at a higher risk of AF, a thromboembolic (TE) stroke or a major haemorrhagic event. This clinical dilemma is further highlighted in those of advanced age who reap the most benefits from anticoagulation, but who are at the highest risk for bleeding complications. To date, two observational studies have examined the outcomes of anticoagulation in patients …

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