Abstract: TH-PO0331
Efficacy and Safety of Warfarin Therapy with Optimal International Normalized Ratio in Patients on Hemodialysis with Atrial Fibrillation
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Tabuchi, Momoko, Division of Nephrology, Kobe University Graduate School of Medicine, Kobe, Hyogo Prefecture, Japan
- Goto, Shunsuke, Division of Nephrology, Kobe University Graduate School of Medicine, Kobe, Hyogo Prefecture, Japan
- Kono, Keiji, Division of Nephrology, Kobe University Graduate School of Medicine, Kobe, Hyogo Prefecture, Japan
- Fujii, Hideki, Division of Nephrology, Kobe University Graduate School of Medicine, Kobe, Hyogo Prefecture, Japan
Background
Warfarin is widely used in patients with atrial fibrillation (AF) to prevent thromboembolic complications. However, its use in chronic hemodialysis (HD) patients remains controversial. This discrepancy may be influenced by whether warfarin therapy is maintained within the target international normalized ratio (INR) range. This study aimed to evaluate the efficacy and safety of warfarin therapy in HD patients with AF, based on whether optimal INR levels were achieved.
Methods
This was an observational multicenter cohort study. We enrolled 256 HD patients with AF from 56 facilities in Hyogo Prefecture, Japan. Patients were classified into three groups: non-warfarin users, warfarin users within the target INR range (1.6–<2.0), and warfarin users outside the target INR range (<1.6 or ≥2.0). We evaluated all-cause death, ischemic stroke or transient ischemic attack (TIA), bleeding events, major adverse cardiovascular events (MACE), and vascular access occlusion or stenosis across the groups using the log-rank test and multivariate Cox proportional hazards models.
Results
Warfarin was prescribed to 83 (32.0%) patients. Of these, 22 patients were within the target INR range, and 61 patients were outside the target range. In the log-rank test, patients within the target range tended to experience fewer vascular access events than those in the other groups (p=0.193). After adjusting for covariates, the incidence of vascular access events was significantly lower in patients within the target INR range compared with the non-warfarin users [HR, 0.25; 95% CI, 0.08-0.81; p=0.021]. In contrast, warfarin users outside the non-target range had a significant higher risk of all-cause mortality compared with the non-warfarin users [HR, 2.01; 95% CI, 1.02-3.96; p=0.043]. The incidences of ischemic stroke/TIA, bleeding events, and MACE were comparable among the three groups.
Conclusion
Our findings suggest that warfarin therapy maintained the target INR range may reduce vascular access events without increasing the risk of all-cause mortality, ischemic stroke/TIA, bleeding events, or MACE in patients undergoing chronic HD.
Funding
- Private Foundation Support