Vitamin K antagonists for stroke prevention in hemodialysis patients with atrial fibrillation: A systematic review and meta-analysis

Meersch, Hans Van Der; Bacquer, Dirk De; Vriese, An S. De

doi:10.1016/j.ahj.2016.09.016

Cited by 91 publications

(73 citation statements)

References 40 publications

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“…We found increased fatal bleeding risks for patients with renal vascular disease, hypertension, diabetes mellitus, pyelonephritis, and multisystem diseases, including patients with granulomatosis with polyangiitis, systemic lupus erythematosus, Henoch–Schönlein purpura, Goodpasture's syndrome, and systemic sclerosis, which are associated with life‐threatening pulmonary bleeding . This was not investigated in previous studies on bleeding complications in dialysis patients . Our findings that older age, male sex and diabetes mellitus were associated with an increased risk of myocardial infarction in dialysis patients is consistent with previous studies .…”

Section: Discussionsupporting

confidence: 87%

“…We found a greatly increased risk for mortality attributable to bleeding in dialysis patients as compared with the general population. Several studies have found increased gastrointestinal bleeding rates ranging from 21 to 161 per 1000 person‐years in dialysis patients , whereas other studies in dialysis patients with atrial fibrillation who received vitamin K antagonists showed increased bleeding rates ranging from 45 to 177 per 1000 person‐years . The mortality rate of 6.2 per 1000 person‐years for fatal bleeding observed in dialysis patients in our study is higher than the mortality rate associated with vitamin K antagonist or direct oral anticoagulant use in non‐dialysis patients, as shown by a recent meta‐analysis of 13 randomized controlled trials involving 102 707 non‐dialysis patients, which showed bleeding rates of 1.6 per 1000 patient‐years in patients receiving direct oral anticoagulants and 3.2 per 1000 patient‐years in patients treated with warfarin .…”

Section: Discussioncontrasting

confidence: 61%

“…Several studies have confirmed this increased bleeding risk in dialysis patients . Most of these studies showed elevated gastrointestinal bleeding rates as compared with the general population, ranging from 21 to 161 per 1000 person‐years .…”

Section: Introductionmentioning

confidence: 85%

“…Most of these studies showed elevated gastrointestinal bleeding rates as compared with the general population, ranging from 21 to 161 per 1000 person‐years . Other studies, focusing on bleeding complications in dialysis patients with atrial fibrillation who received vitamin K antagonists to prevent stroke, showed bleeding rates ranging from 45 to 177 per 1000 person‐years , whereas, in a recent meta‐analysis, the bleeding rate was 3.2 per 1000 patient‐years in non‐dialysis patients treated with vitamin K antagonists . To our knowledge, no previous studies have investigated the incidence of fatal bleeding in dialysis patients as compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

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Mortality due to bleeding, myocardial infarction and stroke in dialysis patients

Ocak

Noordzij

Rookmaaker

et al. 2018

Journal of Thrombosis and Haemostasis

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Background Dialysis has been associated with both bleeding and thrombotic events. However, there is limited information on bleeding as a cause of death versus arterial thrombosis as a cause of death. Objectives To investigate the occurrence of bleeding, myocardial infarction and stroke as causes of death in the dialysis population as compared with the general population. Methods We included 201 918 patients from 11 countries providing data to the ERA-EDTA Registry who started dialysis treatment between 1994 and 2011, and followed them for 3 years. Age-standardized and sex-standardized mortality rate ratios for bleeding, myocardial infarction and stroke as causes of death were calculated in dialysis patients as compared with the European general population. Associations between potential risk factors and these causes of death in dialysis patients were investigated by calculating hazard ratios (HRs) with 95% confidence intervals (CIs) by the use of Cox proportional-hazards regression. Results As compared with the general population, the age-standardized and sex-standardized mortality rate ratios in dialysis patients were 12.8 (95% CI 11.9-13.7) for bleeding as a cause of death (6.2 per 1000 person-years among dialysis patients versus 0.3 per 1000 person-years in the general population), 13.4 (95% CI 13.0-13.9) for myocardial infarction (22.5 versus 0.9 per 1000 person-years), and 12.4 (95% CI 11.9-12.9) for stroke (14.3 versus 0.7 per 1000 person-years). Conclusion Dialysis patients have highly increased risks of death caused by bleeding and arterial thrombosis as compared with the general population. Clinicians should be aware of the increased mortality risks caused by these conditions.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mortality due to bleeding, myocardial infarction and stroke in dialysis patients

Ocak

Noordzij

Rookmaaker

et al. 2018

Journal of Thrombosis and Haemostasis

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“…Tan and colleagues reported an association between warfarin therapy with increased stroke and bleeding events,[27] while the studies by Dahal’s group and van der Meersch et al reported increased bleeding but no effect on stroke or mortality outcomes in hemodialysis patients. [24,28] In recent years, warfarin use has also been associated with increased prevalence and progression of vascular calcification in hemodialysis patients. [20,29] Despite the limited and conflicting evidence for optimal management of long-term anticoagulation in the setting of reduced renal function, data from single-center studies indicates that warfarin is prescribed in 8.3–25% of ESRD patients.…”

Section: Introductionmentioning

confidence: 99%

Warfarin Use and Increased Mortality in End-Stage Renal Disease

Lin

Streja²,

Soohoo³

et al. 2017

Am J Nephrol

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Background: Controversy exists regarding the benefits and risks of warfarin therapy in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In this study, we assessed mortality and cardiovascular outcomes associated with warfarin treatment in patients with stages 3-5 CKD and ESRD admitted to the University of California-Irvine Medical Center. Methods: In a retrospective matched cohort study, we identified 59 adult patients with stages 3-6 CKD initiated on warfarin during the period 2011-2013, and 144 patients with stages 3-6 CKD who had indications for anticoagulation therapy but were not initiated on warfarin. All-cause mortality risk associated with warfarin treatment was estimated using Cox proportional hazard regression analysis, and the risk of significant bleeding and major adverse cardiovascular events were analyzed with Poisson regression analysis. Adjustment models were used to account for age, gender, diabetes mellitus, use of antiplatelet agents, and preexisting cardiovascular disease, and stratified by pre-dialysis CKD stages 3-5 vs. ESRD. Findings: During 5.8 years of follow-up, unadjusted mortality risk was higher in CKD patients on warfarin therapy (hazard ratio [HR] 2.34 with 95% CI 1.25-4.39; p < 0.01). After multivariate adjustment and stratification by CKD stage, the mortality risk remained significant in ESRD patients receiving warfarin (HR 6.62 with 95% CI 2.56-17.16; p < 0.001). Furthermore, adjusted rates of significant bleeding (incident rate ratio, IRR 3.57 with 95% CI 1.51-8.45; p < 0.01) and myocardial infarction (IRR 4.20 with 95% CI 1.78-9.91; p < 0.01) were higher among warfarin users. No differences in rates of ischemic or hemorrhagic strokes were found between the 2 groups. Conclusions: Warfarin use was associated with several-fold higher risk of death, bleeding, and myocardial infarction in dialysis patients. If additional studies suggest similar associations, the use of warfarin in dialysis patients warrants immediate reconsideration.

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Association Between Use of Warfarin for Atrial Fibrillation and Outcomes Among Patients With End-Stage Renal Disease

et al. 2020

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IMPORTANCE Several studies have examined the role of warfarin in preventing strokes in patients with atrial fibrillation and end-stage renal disease; however, the results remain inconclusive. OBJECTIVE To assess recently published studies to examine the outcomes of the use of warfarin among patients with atrial fibrillation and end-stage renal disease. DATA SOURCES A literature search was performed using the terms warfarin and atrial fibrillation and end-stage renal disease and warfarin and atrial fibrillation and dialysis in the MEDLINE, Embase,

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Vitamin K antagonists for stroke prevention in hemodialysis patients with atrial fibrillation: A systematic review and meta-analysis

Cited by 91 publications

References 40 publications

Mortality due to bleeding, myocardial infarction and stroke in dialysis patients

Mortality due to bleeding, myocardial infarction and stroke in dialysis patients

Warfarin Use and Increased Mortality in End-Stage Renal Disease

Association Between Use of Warfarin for Atrial Fibrillation and Outcomes Among Patients With End-Stage Renal Disease

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