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Warfarin use and the risk of stroke, bleeding, and mortality in older adults on dialysis with incident atrial fibrillation
Author(s) -
Tan Jingwen,
Bae Sunjae,
Segal Jodi B,
Zhu Junya,
Alexander G Caleb,
Segev Dorry L,
McAdamsDeMarco Mara
Publication year - 2019
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13207
Subject(s) - medicine , warfarin , atrial fibrillation , stroke (engine) , hazard ratio , dialysis , gastrointestinal bleeding , proportional hazards model , end stage renal disease , cardiology , hemodialysis , confidence interval , mechanical engineering , engineering
Aim There is conflicting evidence regarding the safety and effectiveness of warfarin for atrial fibrillation (AF) treatment among older end‐stage renal disease (ESRD) patients, and differences among subgroups are unclear. Methods Older dialysis patients who were newly diagnosed with AF (7/2007‐12/2011) were identified in the United States Renal Data System. The adjusted hazard ratios (HR) of the outcomes (any stroke, ischaemic stroke, major bleeding, severe gastrointestinal bleeding, and death) by time‐varying warfarin use were estimated using Cox regression accounting for the inverse probability of treatment weight. Results Among 5765 older dialysis patients with incident AF, warfarin was associated with significantly increased risk of major bleeding (HR = 1.50, 95% CI 1.33–1.68), but was not statistically associated with any stroke (HR = 0.92, 95% CI 0.75–1.12), ischaemic stroke (HR = 0.88, 95%CI 0.70–1.11) or gastrointestinal bleeding (HR = 1.03, 95% CI 0.80–1.32). Warfarin use was associated with a reduced risk of mortality (HR = 0.72, 95%CI 0.65–0.80). The association between warfarin and major bleeding differed by sex (male: HR = 1.29; 95%CI 1.08–1.55; female: HR = 1.67; 95%CI 1.44–1.93; P ‐value for interactio n = 0.03). Conclusion Older ESRD patients with AF who were treated with warfarin had a no difference in stroke risk, lower mortality risk, but increased major bleeding risk. The bleeding risk associated with warfarin was greater among women than men. The risk/benefit ratio of warfarin may be less favourable among older women.