Abstract 16149: Warfarin Use is Associated With Reduced Mortality in Hemodialysis Patients With Atrial Fibrillation
Introduction: The optimal management of stroke prophylaxis in hemodialysis patients with atrial fibrillation is controversial. Studies have yielded conflicting results: some studies have suggested warfarin use is associated with an increased risk of stroke and bleeding, while other studies showed that warfarin use lowers risk of stroke and death.
Methods: This is a population-based retrospective cohort study of hemodialysis patients with a diagnosis of atrial fibrillation in the Kaiser Permanente Southern California Health System between Jan 1, 2006 to Sept 30, 2015. Patients with at least 7 days of follow-up were grouped into warfarin users and non-warfarin users based on prescription filled for warfarin. We determined the association between warfarin use and the risk of all-cause death, stroke, and bleeding using Cox-proportional hazard models. Survival curves were estimated using the Kaplan-Meier method and analyzed by log-rank test.
Results: We identified 4286 patients with atrial fibrillation on hemodialysis. Among this group, 989 (23%) patients were prescribed warfarin. When compared to non-warfarin users, patients prescribed warfarin were older, had more congestive heart failure, coronary artery disease, higher CHA2DS2-VASc Score and higher HASBLED score. Warfarin use was associated with lower all-cause death (see figure) (p<0.001). Adjusted Cox-proportional hazard models showed warfarin to be associated with lower risk of all-cause death (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.69-0.84) and lower risk of ischemic stroke (HR 0.66, 95% CI 0.50-0.88). Warfarin use was not associated with a higher risk of hemorrhagic stroke (HR 1.1, 95% CI 0.60-2.0) or gastrointestinal bleed (HR 0.97, CI 0.78-1.2).
Conclusion: In this cohort of hemodialysis patients with atrial fibrillation, warfarin use is associated with lower all-cause death and ischemic stroke but not with more bleeding complications.
Author Disclosures: B. Kai: None. Y. Bogorad: None. L. Nguyen: None. S. Yang: None. A.Y. Shen: None. M. Lee: None.
- © 2016 by American Heart Association, Inc.