The DANWARD trial
Danish Warfarin-Dialysis Study

Aims and objectives

Main objectives: investigate the benefit, tolerability, and safety of warfarin compared with no oral anticoagulation in patients with atrial fibrillation on chronic dialysis.

Main hypothesis: anticoagulation based on warfarin dosing targeting an international normalized ratio (INR) of 2.0 to 3.0 in patients with atrial fibrillation on chronic dialysis reduces the risk of stroke compared to no oral anticoagulation. Although the risk of major bleeding is increased in patients on chronic dialysis, we also hypothesize that warfarin is not associated with an increased risk of major bleeding as defined by the International Society on Thrombosis and Hemostasis compared with no oral anticoagulation.

Study design

The DANWARD trial is an investigator-initiated, prospective, open-label, parallel-group, randomized clinical trial. Patients ≥18 years with atrial fibrillation on chronic hemo- or peritoneal dialysis will be randomized to either oral anticoagulation with warfarin or no oral anticoagulation. Participants will be included from 13 centres across Denmark. Recruitment was initiated in October, 2019.

Publications

Ballegaard ELF et al. Protocol for a randomised controlled trial comparing warfarin with no oral anticoagulation in patients with atrial fibrillation on chronic dialysis: the Danish Warfarin-Dialysis (DANWARD) trial. BMJ Open. 2024 Feb 26;14(2):e081961. doi: 10.1136/bmjopen-2023-081961. PMID: 38413147; PMCID: PMC10900386.

Ballegaard ELF, Olesen JB, Kamper AL, Feldt-Rasmussen B, Gislason G, Torp-Pedersen C, Carlson N. Oral anticoagulation for stroke prevention in atrial fibrillation and advanced kidney disease. Res Pract Thromb Haemost. 2024 Feb 15;8(2):102350. doi: 10.1016/j.rpth.2024.102350. PMID: 38481950; PMCID: PMC10933578.