Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

Chan, Kee; Lazarus, J. Michael; Thadhani, Ravi; Hakim, Raymond M.

doi:10.1681/asn.2009030319

Cited by 398 publications

(425 citation statements)

References 86 publications

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“…Three analyses identified an association between warfarin use and increased risk for bleeding and embolic stroke,11, 12, 13 while the fourth analysis associated warfarin use with an increased risk of bleeding and a decreased risk of stroke or systemic embolism 14. In the present analysis, a trend towards increased bleeding as well as all‐cause stroke, systemic embolism, or TIA was observed in patients with Stage IV or V CKD treated with an OAC compared with patients without CKD that received an OAC.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF

Washam

Holmes

Thomas

et al. 2018

JAHA

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BackgroundChronic kidney disease (CKD) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control.Methods and ResultsPatients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow‐up data were included (N=9019). CKD was defined as an estimated creatinine clearance <60 mL/min. Patient characteristics were compared by CKD status, and Cox proportional hazards modeling was used to examine the association between oral anticoagulant (OAC) use and outcomes and antiarrhythmic drug use and outcomes stratified by CKD stages. At enrollment, 3490 (39%) patients had an estimated creatinine clearance <60 mL/min. Patients with CKD were older and had higher CHA 2 DS 2 VASc and Anticoagulant and Risk Factors in Atrial Fibrillation (ATRIA) scores. A rhythm control strategy was selected less frequently in patients with CKD, while OAC use was lower among Stage IV and V CKD patients. After adjustment, no significant interaction was noted for OAC and CKD on all‐cause mortality (P=0.5442) or cardiovascular death (P=0.1233), although a trend for increased major bleeding (P=0.0608) and stroke, systemic embolism or transient ischemic attack (P=0.0671) was observed. No interaction was noted for antiarrhythmic drug use and CKD status on all‐cause mortality (P=0.9706), or stroke, systemic embolism or transient ischemic attack (P=0.4218).ConclusionsPatients with atrial fibrillation and CKD are less likely to be treated with rhythm control. Patients with advanced CKD are less likely to receive OAC. Finally, outcomes with OAC in patients with advanced CKD may be materially different with higher rates of both bleeding and stroke.

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Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF

Washam

Holmes

Thomas

et al. 2018

JAHA

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“…Nie przeprowadzono żadnych randomizowanych prób klinicznych, w których oceniono by OAC u pacjentów leczonych hemodializami [418] ani kontrolowanych prób klinicznych stosowania NOAC u pacjentów z ciężką CKD (CrCl < 25-30 ml/min) [318][319][320][321]. Stosowanie warfaryny wiązało się z neutralnym lub zwiększonym ryzykiem udaru mózgu w analizach baz danych obejmujących pacjentów dializowanych [419][420][421], w tym w analizie populacyjnej przeprowadzonej w Kanadzie (skorygowany HR udaru mózgu 1,14; 95% CI 0,78-1,67; skorygowany HR krwawienia 1,44; 95% CI 1,13-1,85) [422]. Natomiast dane z Danii wskazują na korzyści z OAC u pacjentów poddawanych leczeniu nerkozastępczemu [423].…”

Section: Doustne Leczenie Przeciwzakrzepowe U Dializowanych Pacjentówunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,399

4,206

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“…Implementation of company-wide data collection processes maintained the uniform collection and entry of patient data across all facilities. Further description of the data records can be found in previously published studies (12)(13)(14). …”

Section: Patient Populationmentioning

confidence: 99%

The “Right” of Passage

Wingard

Chan

Lazarus

et al. 2009

Clinical Journal of the American Society of Nephrology

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Mortality risk for dialysis patients is highest in the first year. We previously showed a 41% mortality benefit associated with a pilot case management program for incident hemodialysis patients (n ‫؍‬ 918). The RightStart Program (RSP) provided prompt medical management and self-management education and was recently expanded to more facilities. We conducted a matched cohort analysis to validate the expanded program's continued effectiveness. Death risk was reduced for RS patients (n ‫؍‬ 4308) versus matched controls (C; n ‫؍‬ 4308) by 34% (hazard ratio ‫؍‬ 0.66, P < 0.0001) at 120 d and 22% at 1 yr (hazard ratio ‫؍‬ 0.78, P < 0.0001). RS patients had lower hospitalization during the first year (RS ‫؍‬ 15.5 days per patient year versus C ‫؍‬ 16.9, P < 0.01). At 120 d, more RS patients achieved hemoglobin 11 to 12 g/dl (RS ‫؍‬ 22.4% versus C ‫؍‬ 19.7%, P < 0.01), eKt/V > 1.2 (RS ‫؍‬ 66% versus C ‫؍‬ 53.5%, P < 0.01), albumin > 4.0 g/dl (RS ‫؍‬ 26% versus C ‫؍‬ 22%, P < 0.01), and phosphorus 3.5 to 5.5 mg/dl (RS ‫؍‬ 52.4% versus C ‫؍‬ 45.4%). At 120 d, RS patients had a greater reduction in catheter use (RS ‫؍‬ 32% versus C ‫؍‬ 25%, P < 0.01) and more vitamin D orders (RS ‫؍‬ 60% versus C ‫؍‬ 55%, P < 0.01). Expansion of RS to a larger incident patient population results in significant reduction of morbidity and mortality associated with improvement of intermediate outcomes.

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Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

Cited by 398 publications

References 86 publications

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

The “Right” of Passage

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