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Abstract: TH-PO426

Association Between Warfarin Use and Clinical Outcomes in Late-Stage CKD Patients with Atrial Fibrillation

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Agarwal, Manyoo, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Naseer, Adnan, Memphis VA Medical Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • George, Lekha K., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Koshy, Santhosh K., Regional One Health - University of TN Health Sciences Ctr, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
Background

The effect of warfarin on clinical outcomes in late-stage chronic kidney disease (CKD) patients with atrial fibrillation (AF) is unclear.

Methods

We examined a national cohort of 23,201 US veterans with incident end stage renal disease (ESRD) who developed incident AF prior to initiating renal replacement therapy. We examined the association of warfarin therapy following the diagnosis of AF with cerebrovascular accidents (CVA) (ischemic stroke or transient ischemic attack), hemorrhagic strokes, post-dialysis fatal bleeding and all-cause mortality in multivariable adjusted time dependent Cox models adjusting for demographic characteristics and comorbidities.

Results

Patients were 77±9 year old, 95% male, 13% African-American, 99% hypertensive, 79% diabetic, and 88%, 88% and 64% had histories of ischemic heart disease, congestive heart failure and CVA, respectively. 5,632 (24.3%) patients received treatment with warfarin during the study period. As shown in the Table, the risk of all outcomes except all-cause mortality were higher in those exposed to warfarin when compared to those not exposed to warfarin. These differences in outcomes remained significant even after multivariable adjustment, except fatal bleeding events, which showed no significant associaiton (Table).

Conclusion

Warfarin use in advanced CKD is associated with higher risk of ischemic and hemorrhagic CVA, but lower risk of mortality after ESRD transition. Randomized controlled trials are needed to determine the risks and benefit of warfarin therapy in patients with incident AF and advanced CKD.

 Overall
1000 patient years
[95% CI]
No-Warfarin Exposure
1000 patient years
[95% CI]
Warfarin Exposure
1000 patient years
[95% CI]
Adjusted Hazard Ratio for Warfarin Exposure
(95% CI)
All-cause mortality469.7
[463.0-476.4]
496.2
[487.9-504.6]
416.3
[405.6- 427.4]
0.93
[0.90- 0.96]
Ischemic
CVA
65.5
[64.3- 66.8]
61.6
[60.3-62.9]
97.7
[93.1-102.4]
1.39
[1.31- 1.48]
Hemorrhagic Stroke8.6
[8.2 – 9.1]
7.6
[7.2-8.0]
15.5
[14.1-17.1]
1.52
[1.32- 1.75]
Fatal Bleeding Event7.4
[6.6- 8.3]
8.1
[7.1-9.3]
6.1
[4.9-7.6]
0.86
[0.62 – 1.19]

Funding

  • NIDDK Support