Should vitamin K antagonists ever be used in ESRD?

Warfarin produced a similar proportional increase in progression in ESRD patients, but because of the underlying propensity towards arterial calcification in ESRD, the rate of progression in ESRD patients treated with warfarin was almost 20-fold greater than in women without ESRD not treated with warfarin. One could argue that it could be used in patients with excellent control of their mineral metabolism but our data show that warfarin increases arterial calcification in patients with normal renal function and presumably normal mineral metabolism. Patients with end-stage renal disease (ESRD) often have indications for long-term anticoagulation such as atrial fibrillation, thrombosis of arteriovenous fistulas and grafts, metallic heart valves, and hypercoagulable states. [Extracted from the article]