Abstract: FR-PO838

Oral Anticoagulation Among Patients Initiating Dialysis with Existing Atrial Fibrillation/Flutter: Association with Outcomes and Risk Score

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Albright, Robert C., Mayo Clinic, Rochester, Minnesota, United States
  • Dillon, John J., Mayo Clinic, Rochester, Minnesota, United States
  • Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
Background

In the general population, systemic oral anticoagulation (SOA) may reduce stroke risk among patients with atrial fibrillation/flutter (Afib). Patients who develop Afib after starting hemodialysis (HD) do not typically benefit from SOA. Guidance for use of SOA among patients who initiate HD with pre-existing Afib is scant.

Methods

This study considered adult Medicare A, B, and D beneficiaries who initiated in-center HD at a large US dialysis organization in 2010 or 2011 with a pre-existing diagnosis of Afib, ascertained from claims data. SOA (exposure) was based on a Medicare D claim for a prescription fill during the first 3 months of HD. Outcomes were considered from HD start until death, loss to follow-up, or study end (31 Dec 2012). Comparisons were made using intention-to-treat principles and negative binomial (hospitalization) or Cox proportional hazard (death, stroke, ischemic stroke, and stroke/transient ischemic attack [TIA]) models adjusted for imbalanced characteristics.

Results

Among 2742 patients initiating HD with Afib, 835 had a fill for SOA, and 1907 did not. No independent association was observed between SOA and any outcome considered. No protective association of SOA was observed in patients with high (or low) CHA2DS2-VASc risk score (p-interaction > 0.1 for each). No association was observed between SOA use and risk of gastrointestinal bleed.

Conclusion

Among patients who initiate HD with pre-exisiting Afib, traditionally accepted stroke risk scores cannot adequately guide clinicians with respect to possible benefit of SOA. Alternate methods are needed to guide use of SOA in such patients.

Funding

  • Commercial Support