Abstract: TH-PO426
Association Between Warfarin Use and Clinical Outcomes in Late-Stage CKD Patients with Atrial Fibrillation
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors, Prevention
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 mortality | 469.7 [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 Stroke | 8.6 [8.2 – 9.1] | 7.6 [7.2-8.0] | 15.5 [14.1-17.1] | 1.52 [1.32- 1.75] |
| Fatal Bleeding Event | 7.4 [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