Warfarin use associates with increased risk for stroke in hemodialysis patients with atrial fibrillation
Open accessAbstract
Use of warfarin, clopidogrel, or aspirin associates with mortality among patients with ESRD, but the risk-benefit ratio may depend on underlying comorbidities. Here, we investigated the association between these medications and new stroke, mortality, and hospitalization in a retrospective cohort analysis of 1671 incident hemodialysis patients with preexisting atrial fibrillation. We followed patient outcomes from the time of initiation of dialysis for an average of 1.6 yr. Compared with nonuse, warfarin use associated with a significantly increased risk for new stroke (hazard ratio 1.93; 95% confidence interval 1.29 to 2.90); clopidogrel or aspirin use did not associate with increased risk for new stroke. Analysis using international normalized ratio (INR) suggested a dose-response relationship between the degree of anticoagulation and new stroke in patients on warfarin (P = 0.02 for trend). Warfarin users who received no INR monitoring in the first 90 d of dialysis had the highest risk for stroke compared with nonusers (hazard ratio 2.79; 95% confidence interval 1.65 to 4.70). Warfarin use did not associate with statistically significant increases in all-cause mortality or hospitalization. In conclusion, warfarin use among patients with both ESRD and atrial fibrillation associates with an increased risk for stroke. The risk is greatest in warfarin users who do not receive in-facility INR monitoring.
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Warfarin use was associated either with a neutral or increased risk of stroke in database analyses of patients on dialysis, including a population-based analysis in Canada (adjusted HR for stroke 1.14; 95% CI 0.78-1.67, adjusted HR for bleeding 1.44; 95% CI 1.13-1.85).
“Warfarin use was associated either with a neutral or increased risk of stroke in database analyses of patients on dialysis, [419][420][421] including a population-based analysis in Canada (adjusted HR for stroke 1.14; 95% CI 0.78-1.67,adjusted HR for bleeding 1.44; 95% CI 1.13-1.85).422”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [420]
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Stroke and bleeding in atrial fibrillation with chronic kidney disease
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Herzog, C. A., ASINGER, R. W., Berger, A. K., Charytan, D. M., Dı́ez, J., Hart, R. G., Eckardt, K., Kasiske, B. L., McCullough, P. A., PASSMAN, R. S., et al. (2011) · Kidney International · doi:10.1038/ki.2011.223 · Cited by 918 · see citing works
“One large retrospective study of hemodialysis patients with atrial fibrillation found that increasing age, CHF, and systolic BP correlated with stroke risk.(140) Multivariate analysis of another study reported that previous stroke, diabetes, and advancing age independently predicted hospitalization for stroke, but hyp…”
BackgroundResultInfluentialSkanes, A. C., Healey, J. S., Cairns, J. A., Dorian, P., Gillis, A. M., McMurtry, M. S., Mitchell, L. B., Verma, A., & Nattel, S. (2012) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2012.01.021 · Cited by 494 · see citing works
“5% nonuse).(46) A large retrospective cohort study evaluated 41,425 patients with incident hemodialysis but not necessarily AF, and found increased mortality with warfarin (RR 1.”
BackgroundShah, M., Tsadok, M. A., Jackevicius, C. A., Essebag, V., Eisenberg, M. J., Rahme, E., Humphries, K. H., Tu, J. V., Behlouli, H., Guo, H., et al. (2014) · Circulation · doi:10.1161/circulationaha.113.004777 · Cited by 336 · see citing works
Dabigatran and Rivaroxaban Use in Atrial Fibrillation Patients on Hemodialysis
Chan, K. E., Edelman, E. R., Wenger, J., Thadhani, R., & Maddux, F. W. (2015) · Circulation · doi:10.1161/circulationaha.114.014113 · Cited by 325 · see citing works
Brodsky, S. V., Nádasdy, T., Rovin, B. H., Satoskar, A. A., Nadasdy, G. M., Wu, H. M., Bhatt, U. Y., & Hebert, L. A. (2011) · Kidney International · doi:10.1038/ki.2011.44 · Cited by 312 · see citing works
Zimmerman, D. L., Sood, M. M., Rigatto, C., Holden, R. M., Hiremath, S. S., & Clase, C. M. (2012) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfs416 · Cited by 308 · see citing works
“study, which reported an increased risk of stroke in association with warfarin use, the greatest risk of stroke was in patients without in-facility monitoring of INR [20].”
InfluentialBonde, A. N., Lip, G. Y. H., Kamper, A., Hansen, P. R., Lamberts, M., Hommel, K., Hansen, M. L., Gislason, G., Torp-Pedersen, C. T., & Olesen, J. B. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.09.051 · Cited by 284 · see citing works
Winkelmayer, W. C., Liu, J., Setoguchi, S., & Choudhry, N. K. (2011) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.04550511 · Cited by 280 · see citing works
“Our findings differ from those observed in a recent study of 1671 patients who already had AF when starting hemodialysis with a national dialysis provider and survived 90 days from initiation (7).”
ResultThe Increasing Prevalence of Atrial Fibrillation among Hemodialysis Patients
Winkelmayer, W. C., Patrick, A. R., Liu, J., Brookhart, M. A., & Setoguchi, S. (2011) · Journal of the American Society of Nephrology · doi:10.1681/asn.2010050459 · Cited by 275 · see citing works
Kirchhof, P. F., Lip, G. Y. H., Gelder, I. C. V., Bax, J. J., Hylek, E. M., Kääb, S., Schotten, U., Wegscheider, K., Boriani, G., Brandes, A., et al. (2011) · EP Europace · doi:10.1093/europace/eur241 · Cited by 242 · see citing works
Pokorney, S. D., Chertow, G. M., Al‐Khalidi, H. R., Gallup, D. S., Dignacco, P., Mussina, K., Bansal, N., Gadegbeku, C. A., Garcia, D. A., Merali, S. J., et al. (2022) · Circulation · doi:10.1161/circulationaha.121.054990 · Cited by 240 · see citing works
“Major bleeding-related death* 1 (1) 2 (3)”
MethodCirculating Nonphosphorylated Carboxylated Matrix Gla Protein Predicts Survival in ESRD
Schlieper, G., Westenfeld, R., Krüger, T., Cranenburg, E. C. M., Magdeleyns, E. J. P., Brandenburg, V. M., Djurić, Ž., Damjanović, T., Ketteler, M., Vermeer, C., et al. (2011) · Journal of the American Society of Nephrology · doi:10.1681/asn.2010040339 · Cited by 232 · see citing works
Apixaban Pharmacokinetics at Steady State in Hemodialysis Patients
Mavrakanas, T. A., Samer, C. F., Nessim, S. J., Frisch, G., & Lipman, M. L. (2017) · Journal of the American Society of Nephrology · doi:10.1681/asn.2016090980 · Cited by 229 · see citing works
Chan, K. E., Giugliano, R. P., Patel, M. R., Abramson, S., Jardine, M., Zhao, S. J., Perkovic, V., Maddux, F. W., & Piccini, J. P. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.02.082 · Cited by 227 · see citing works
Dahal, K. B., Kunwar, S., Rijal, J. P., Schulman, P. M., & Lee, J. (2015) · CHEST Journal · doi:10.1378/chest.15-1719 · Cited by 224 · see citing works
Warfarin in atrial fibrillation patients with moderate chronic kidney disease
Hart, R. G., Pearce, L. A., Asinger, R. W., & Herzog, C. A. (2011) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.02400311 · Cited by 204 · see citing works
A case-control study of calciphylaxis in Japanese end-stage renal disease patients
Hayashi, M., Takamatsu, I., Kanno, Y., Yoshida, T., Abe, T., Sato, Y., & for the Japanese Calciphylaxis Study Group (2011) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfr658 · Cited by 199 · see citing works
“It was recently reported that warfarin therapy might facilitate vascular calcification in dialysis patients [15] and that warfarin therapy increases the incidence of stroke [16].”
BackgroundSevere Renal Impairment and Stroke Prevention in Atrial Fibrillation
Marinigh, R., Lane, D. A., & Lip, G. Y. H. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.12.013 · Cited by 195 · see citing works
2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation
Chiang, C., Okumura, K., Zhang, S., Chao, T., Siu, C., Lim, T. W., Saxena, A., Takahashi, Y., & Teo, W. S. (2017) · Journal of Arrhythmia · doi:10.1016/j.joa.2017.05.004 · Cited by 198 · see citing works
“Several observational studies have raised concerns about the use of warfarin in dialysis patients with non-valvular AF [84,87,182].”
BackgroundVascular calcification: The price to pay for anticoagulation therapy with vitamin K-antagonists
Chatrou, M. L. L., Winckers, K., Hackeng, T. M., Reutelingsperger, C. P. M., & Schurgers, L. J. (2012) · Blood Reviews · doi:10.1016/j.blre.2012.03.002 · Cited by 177 · see citing works
Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation
Kumar, S., Lim, E., Covic, A. C., Verhamme, P. B., Gale, C. P., Camm, A. J., & Goldsmith, D. J. A. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.08.1031 · Cited by 176 · see citing works
Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Dialysis
Kuno, T., Takagi, H., Ando, T., Sugiyama, T., Miyashita, S., Valentin, N., Shimada, Y. J., Kodaira, M., Numasawa, Y., Briasoulis, Α., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.10.059 · Cited by 173 · see citing works
Carrero, J. J., Evans, M., Szummer, K. E., Spaak, J., Lindhagen, L., Edfors, R., Stenvinkel, P., Jacobson, S. H., & Jernberg, T. (2014) · JAMA · doi:10.1001/jama.2014.1334 · Cited by 157 · see citing works
2018 Korean Guideline of Atrial Fibrillation Management
Joung, B., Lee, J., Lee, K. H., Kim, T., Choi, E., Lim, W., Kang, K., Uhm, J., Lim, H. E., Park, J., et al. (2018) · Korean Circulation Journal · doi:10.4070/kcj.2018.0339 · Cited by 154 · see citing works
Incidence of Stroke Before and After Dialysis Initiation in Older Patients
Murray, A. M., Seliger, S. L., Lakshminarayan, K., Herzog, C. A., & Solid, C. A. (2013) · Journal of the American Society of Nephrology · doi:10.1681/asn.2012080841 · Cited by 147 · see citing works
Anticoagulation in chronic kidney disease patients--the practical aspects
Hughes, S., Szeki, I., Nash, M. J., & Thachil, J. V. (2014) · Clinical Kidney Journal · doi:10.1093/ckj/sfu080 · Cited by 145 · see citing works
“This in the setting of bleeding risk put such patients at higher risk of bleeding [44].”
BackgroundJun, M., James, M. T., Manns, B. J., Quinn, R. R., Ravani, P., Tonelli, M., Perkovic, V., Winkelmayer, W. C., Ma, Z., Hemmelgarn, B. R., et al. (2015) · BMJ · doi:10.1136/bmj.h246 · Cited by 143 · see citing works
Randhawa, M. S., Vishwanath, R., Rai, M. P., Wang, L., Randhawa, A. K., Abela, G. S., & Dhar, G. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.2175 · Cited by 144 · see citing works
Atrial Fibrillation and Thromboembolism in Patients With Chronic Kidney Disease
Lau, Y. C., Proietti, M., Guiducci, E., Blann, A. D., & Lip, G. Y. H. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.06.057 · Cited by 144 · see citing works
“Several large studies (104,105,108) have demonstrated that AF patients who are receiving hemodialysis and taking warfarin experienced a more than 2-fold increase in the risk of ischemic stroke compared to non-VKA users.”
BackgroundPathophysiology of atrial fibrillation and chronic kidney disease
Ding, W. Y., Gupta, D., Wong, C. F., & Lip, G. Y. H. (2020) · Cardiovascular Research · doi:10.1093/cvr/cvaa258 · Cited by 141 · see citing works
Hirakata, H., Nitta, K., Inaba, M., Shoji, T., Fujii, H., Kobayashi, S., Tabei, K., Joki, N., Hase, H., Nishimura, M., et al. (2012) · Therapeutic apheresis and dialysis · doi:10.1111/j.1744-9987.2012.01088.x · Cited by 110 · see citing works
Shen, J. I., Montez‐Rath, M. E., Lenihan, C. R., Turakhia, M. P., Chang, T. I., & Winkelmayer, W. C. (2015) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2015.05.019 · Cited by 135 · see citing works
“91).(6) Warfarin use was also associated with higher risks of any stroke in hemodialysis patients older than 75 years (HR, 2.”
BackgroundLutz, J., Jurk, K., & Schinzel, H. (2017) · International Journal of Nephrology and Renovascular Disease · doi:10.2147/ijnrd.s105771 · Cited by 130 · see citing works
“However, this was dependent on INR-monitoring, as patients without an adequate INR monitoring during the first 90 days after treatment initiation had significantly increased risk for strokes as compared to patients without warfarin treatment.(22) Another report from the Dialysis Outcomes and Practice Patterns Study da…”
Use of oral anticoagulants in patients with atrial fibrillation and renal dysfunction
Potpara, T., Ferro, C. J., & Lip, G. Y. H. (2018) · Nature Reviews Nephrology · doi:10.1038/nrneph.2018.19 · Cited by 128 · see citing works
Roldán, V., Marín, F., Fernández, H., Manzano-Fernández, S., Gallego, P., Valdés, M., Vicente, V., & Lip, G. Y. H. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.12.045 · Cited by 117 · see citing works
“A greater rate of stroke in anticoagulated patients with AF requiring hemodialysis compared to that in nonwarfarin users has been reported.(27) Poor control of anticoagulation might be contributory, so, careful monitoring to ensure a longer time in the therapeutic range would be prudent.”
BackgroundDelanaye, P., Krzesinski, J.-M., Warling, X., Moonen, M., Smelten, N. S., Médart, L., Pottel, H., & Cavalier, E. (2014) · BMC Nephrology · doi:10.1186/1471-2369-15-145 · Cited by 118 · see citing works
“Several authors have suggested that VKA treatment is a risk factor for vascular calcifications or calciphylaxis in HD patients but this assertion deserves further study [24,32,35,39-46].”
BackgroundSood, M. M., Larkina, M., Thumma, J. R., Tentori, F., Gillespie, B. W., Fukuhara, S., Mendelssohn, D. C., Chan, K. T. K., de Sequera, P., Komenda, P. V. J., et al. (2013) · Kidney International · doi:10.1038/ki.2013.170 · Cited by 112 · see citing works
Safety and effectiveness of apixaban compared to warfarin in dialysis patients
Reed, D. R., Palkimas, S., Hockman, R. H., Abraham, S., Le, T. M., & Maitland, H. S. (2018) · Research and Practice in Thrombosis and Haemostasis · doi:10.1002/rth2.12083 · Cited by 110 · see citing works
Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation
Genovesi, S., Rossi, E., Gallieni, M. A., Stella, A., Badiali, F., Conte, F., Pasquali, S., Bertoli, S. V., Ondei, P., Bonforte, G., et al. (2014) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfu334 · Cited by 108 · see citing works
“Some studies are based on large databases, but they also draw conclusions from retrospectively collected and analysed registry data [10, 12, 13] or from a post hoc analyses made on the results of trials designed for other purposes [11, 14].”
BackgroundResultInfluentialWetmore, J. B., Mahnken, J. D., Rigler, S. K., Ellerbeck, E. F., Mukhopadhyay, P., Spertus, J. A., Hou, Q., & Shireman, T. I. (2011) · Kidney International · doi:10.1038/ki.2011.416 · Cited by 106 · see citing works
Mavrakanas, T. A., Garlo, K. G., & Charytan, D. M. (2020) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.11650919 · Cited by 104 · see citing works
Dad, T., & Weiner, D. E. (2015) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2015.06.003 · Cited by 99 · see citing works
Mortality and Associated Risk Factors in Dialysis Patients with Cardiovascular Disease
Tong, J., Liu, M., Li, H., Luo, Z., Zhong, X., HUANG, J. C., Liu, R., He, F., & Fu, J. (2016) · Kidney & Blood Pressure Research · doi:10.1159/000443449 · Cited by 97 · see citing works
Digoxin Associates with Mortality in ESRD
Chan, K. E., Lazarus, J. M., & Hakim, R. M. (2010) · Journal of the American Society of Nephrology · doi:10.1681/asn.2009101047 · Cited by 97 · see citing works
Meersch, H. V. D., Bacquer, D. D., & Vriese, A. S. D. (2016) · American Heart Journal · doi:10.1016/j.ahj.2016.09.016 · Cited by 96 · see citing works
Tan, J., Liu, S., Segal, J. B., Alexander, G. C., & McAdams‐DeMarco, M. (2016) · BMC Nephrology · doi:10.1186/s12882-016-0368-6 · Cited by 93 · see citing works
“Chan 2009 [30] US, Fresenius clinics 1.”
BackgroundMethodResultInfluentialStroke Prevention in Atrial Fibrillation Patients With Chronic Kidney Disease
Hart, R. G., Eikelboom, J. W., Brimble, K. S., McMurtry, M. S., & Ingram, A. J. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.04.005 · Cited by 89 · see citing works
Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients
Miglinas, M., Cesniene, U., Janusaite, M. M., & Vinikovas, A. (2020) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2020.00096 · Cited by 91 · see citing works
Königsbrügge, O., Posch, F., Antlanger, M., Kovařík, J., Klauser‐Braun, R., Kletzmayr, J., Schmaldienst, S., Auinger, M., Zuntner, G., Lorenz, M., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0169400 · Cited by 83 · see citing works
Appraising Stroke Risk in Maintenance Hemodialysis Patients: A Large Single-Center Cohort Study
Power, A. J., Chan, K., Singh, S. K., Taube, D. H., & Duncan, N. D. (2011) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2011.07.016 · Cited by 85 · see citing works
Kumar, S., de Lusignan, S., McGovern, A. P., Correa, A., Hriskova, M., Gatenby, P. A. C., Jones, S., Goldsmith, D. J. A., & Camm, A. J. (2018) · BMJ · doi:10.1136/bmj.k342 · Cited by 82 · see citing works
Atrial Fibrillation in CKD: Balancing the Risks and Benefits of Anticoagulation
Ng, K. P., Edwards, N. C., Lip, G. Y. H., Townend, J., & Ferro, C. J. (2013) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2013.02.381 · Cited by 82 · see citing works
Harel, Z., Chertow, G. M., Shah, P. S., Harel, S., Dorian, P., Yan, A. T.-K., Saposnik, G., Sood, M. M., Molnar, A. O., Perl, J. M., et al. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.02.004 · Cited by 79 · see citing works
Szummer, K. E., Gasparini, A., Eliasson, S., Ärnlöv, J., Qureshi, A. R., Barany, P. F., Evans, M., Friberg, L., & Carrero, J. J. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.116.004925 · Cited by 82 · see citing works
“We speculated that poor TTR may, in part, explain the worse outcome and higher bleeding rate described in observational studies of CKD patients on warfarin, particularly among those undergoing dialysis.(26,27) We observed no interaction between TTR and eGFR and outcome in our study, suggesting that both factors affect…”
ResultAnticoagulants in atrial fibrillation patients with chronic kidney disease
Hart, R. G., Eikelboom, J. W., Ingram, A. J., & Herzog, C. A. (2012) · Nature Reviews Nephrology · doi:10.1038/nrneph.2012.160 · Cited by 75 · see citing works
Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation
Shih, C.-J., Ou, S., Chao, P.-W., Kuo, S., Lee, Y.-J., Yang, C., Tarng, D., Lin, C., Huang, P., Li, S., et al. (2016) · Circulation · doi:10.1161/circulationaha.115.018294 · Cited by 78 · see citing works
“However, we need to acknowledge that the efficacy of warfarin treatment for stroke prevention in dialysis patients with AF is beyond the scope of the present study because of unavailable information about warfarin use in our claims database, such as adherence to prescribed warfarin and therapeutic values of internatio…”
BackgroundRisk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis
Findlay, M., Thomson, P. C., Fulton, R. L., Solbu, M. D., Jardine, A. G., Patel, R. K., Stevens, K. K., Geddes, C., Dawson, J., & Mark, P. B. (2015) · Stroke · doi:10.1161/strokeaha.115.009095 · Cited by 75 · see citing works
Ischaemic stroke in incident dialysis patients
Sánchez-Perales, C., Vázquez, E., Garcı́a-Cortes, M. J., Borrego, J., Polaina, M., Gutierrez, C. P., Lozano, C., & Liébana, A. (2010) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfq220 · Cited by 73 · see citing works
“the relationship between ischaemic stroke and AF in the dialysis population is invaluable in establishing indications for anti-thrombotic treatment in this population; albeit, the risk associated with this therapy in the dialysis population has not as yet been sufficiently clarified [28–33].”
BackgroundStroke in patients with chronic kidney disease…: How do we approach and manage it?
Nayak‐Rao, S., & Shenoy, M. P. (2017) · Indian Journal of Nephrology · doi:10.4103/0971-4065.202405 · Cited by 73 · see citing works
“In a retrospective cohort study[16] of incident ESRD patients with co‐existing AF, warfarin use was associated with an increased risk of stroke presumably hemorrhagic stroke even after controlling for potential confounders.”
BackgroundAnticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach
Kessler, M., Moureau, F., & Nguyên, P. (2015) · Seminars in Dialysis · doi:10.1111/sdi.12380 · Cited by 71 · see citing works
Mechanisms and treatment of extraosseous calcification in chronic kidney disease
Ketteler, M., Rothe, H. M., Krüger, T., Biggar, P. H., & Schlieper, G. (2011) · Nature Reviews Nephrology · doi:10.1038/nrneph.2011.91 · Cited by 69 · see citing works
“published data from a retrospective cohort analysis of 1,671 prevalent hemodialysis patients with atrial fibrillation”
Chan, K. E., Ikizler, T. A., Gamboa, J. L., Yu, C., Hakim, R. M., & Brown, N. J. (2011) · Kidney International · doi:10.1038/ki.2011.228 · Cited by 67 · see citing works
“[34–37] Chan et al.”
Providencia, R. A., Marijon, É., Bovéda, S., Barra, S., Narayanan, K., Heuzey, J. L., Gersh, B. J., & Gonçalves, L. M. M. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.05.048 · Cited by 66 · see citing works
Chokesuwattanaskul, R., Thongprayoon, C., Tanawuttiwat, T., Kaewput, W., Pachariyanon, P., & Cheungpasitporn, W. (2018) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13331 · Cited by 68 · see citing works
Wakasugi, M., Kazama, J. J., Tokumoto, A., Suzuki, K., Kageyama, S., Ohya, K., Miura, Y., Kawachi, M., Takata, T., Nagai, M., et al. (2013) · Clinical and Experimental Nephrology · doi:10.1007/s10157-013-0885-6 · Cited by 66 · see citing works
“0 had a significantly higher risk of stroke [8].”
BackgroundResultWarfarin in haemodialysis patients with atrial fibrillation: what benefit?
Yang, F., Chou, D. E., Schweitzer, P., & Hanon, S. (2010) · EP Europace · doi:10.1093/europace/euq387 · Cited by 64 · see citing works
Atrial fibrillation and risk of stroke in dialysis patients
Wetmore, J. B., Ellerbeck, E. F., Mahnken, J. D., Phadnis, M. A., Rigler, S. K., Mukhopadhyay, P., Spertus, J. A., Zhou, X., Hou, Q., & Shireman, T. I. (2013) · Annals of Epidemiology · doi:10.1016/j.annepidem.2012.12.011 · Cited by 65 · see citing works
“Finally, to compare results of our dually-eligible population to that of other populations [4, 14], we tested whether the CHADS2 risk stratification scheme used in the general population to predict stroke risk in patients with AF [15] would perform well in broadly risk-stratifying duallyeligible chronic dialysis patie…”
BackgroundResultInfluentialStroke in Dialysis and Chronic Kidney Disease
Power, A. J. (2013) · Blood Purification · doi:10.1159/000356086 · Cited by 62 · see citing works
Kim, J. S., & Hwang, H. S. (2021) · Korean Circulation Journal · doi:10.4070/kcj.2021.0995 · Cited by 59 · see citing works
Stroke prevention strategies in high-risk patients with atrial fibrillation
Kotalczyk, A., Mazurek, M., Kalarus, Z. F., Potpara, T., & Lip, G. Y. H. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00459-3 · Cited by 60 · see citing works
Chronic Kidney Disease and Stroke
Husseini, N. E., Kaskar, O. B., & Goldstein, L. B. (2014) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2014.09.001 · Cited by 57 · see citing works
Systemic Anticoagulation Considerations in Chronic Kidney Disease
Dager, W. E., & Kiser, T. H. (2010) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2010.06.002 · Cited by 57 · see citing works
“Because of the complexity of managing warfarin, and increased risk of adverse outcomes in the CKD setting, warfarin management should be deferred when possible to dedicated anticoagulation services.(15)”
BackgroundWang, T. K. M., Sathananthan, J., Marshall, M. R., Kerr, A., & Hood, C. (2015) · Heart Lung and Circulation · doi:10.1016/j.hlc.2015.08.012 · Cited by 57 · see citing works
“Mixed results have been reported in other studies, that warfarin also has no effect [5,9,12,13,22] or even increases [10,11] the risk of ischaemic strokes in dialysis patients with AF.”
ResultInfluentialChan, P., Huang, D., Yip, P.-S., Hai, J. J., Tse, H., Chan, T. M., Lip, G. Y. H., Lo, W.-K., & Siu, C. (2015) · EP Europace · doi:10.1093/europace/euv289 · Cited by 55 · see citing works
“Likewise, in a cohort of 1671 haemodialysis patients with AF from North America, warfarin therapy was associated with nearly two-fold increase in stroke.(12) On the other hand, the risk of haemorrhagic stroke amongst haemodialysis patients with AF receiving also increases substantially.”
BackgroundSu, X., Yan, B., Wang, L., Lv, J., Cheng, H., & Chen, Y. (2021) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2021.02.328 · Cited by 53 · see citing works
A systematic review of the efficacy and safety of anticoagulants in advanced chronic kidney disease
Parker, K., Hartemink, J., Saha, A., Mitra, R., Lewis, P. J., Power, A. J., Choudhuri, S., Mitra, S., & Thachil, J. V. (2022) · Journal of Nephrology · doi:10.1007/s40620-022-01413-x · Cited by 58 · see citing works
“However, there were nine studies in dialysis patients that found no difference in major bleeding between those anticoagulated and not [5, 49, 51, 52, 55, 63, 64, 66, 68].”
BackgroundChen, H.-Y., Ou, S., Huang, C., Lee, P., Chou, K.-J., Lin, P., & Su, Y. (2021) · Clinical Drug Investigation · doi:10.1007/s40261-021-01016-7 · Cited by 54 · see citing works
Cardiovascular disease and chronic kidney disease
Gargiulo, R., Suhail, F., & Lerma, E. V. (2015) · Disease-a-Month · doi:10.1016/j.disamonth.2015.07.005 · Cited by 54 · see citing works
Role of direct oral anticoagulants in patients with kidney disease
Derebail, V. K., Rheault, M. N., & Kerlin, B. A. (2019) · Kidney International · doi:10.1016/j.kint.2019.11.027 · Cited by 55 · see citing works
Pokorney, S. D., Black‐Maier, E., Hellkamp, A. S., Friedman, D. J., Vemulapalli, S., Granger, C. B., Thomas, L. E., Peterson, E. D., & Piccini, J. P. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.01.019 · Cited by 53 · see citing works
Oral Anticoagulant Therapy in Atrial Fibrillation Patients at High Stroke and Bleeding Risk
Potpara, T., & Lip, G. Y. H. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.07.003 · Cited by 51 · see citing works
“of warfarin in those with AF [62, 75, 76], whilst warfarin (but not aspirin) treatment was associated with a significant reduction of stroke or systemic embolism (HR 0.”
BackgroundEvidence for the Prevention and Treatment of Stroke in Dialysis Patients
Herrington, W. G., Haynes, R., Staplin, N., Emberson, J., Baigent, C., & Landray, M. (2014) · Seminars in Dialysis · doi:10.1111/sdi.12281 · Cited by 51 · see citing works
“Five recent observational analyses of the association between warfarin prescription and stroke in those on dialysis with AF have yielded conflicting results (perhaps reflecting different amounts of residual confounding between these studies (75)): one study in US dialysis patients with AF found warfarin prescription t…”
ResultNochaiwong, S., Ruengorn, C., Awiphan, R., Dandecha, P., Noppakun, K., & Phrommintikul, A. (2016) · Open Heart · doi:10.1136/openhrt-2016-000441 · Cited by 52 · see citing works
Evidence-Based Cardiology in Hemodialysis Patients
Allon, M. (2013) · Journal of the American Society of Nephrology · doi:10.1681/asn.2013060632 · Cited by 50 · see citing works
Cardiovascular Risk Assessment Before and After Kidney Transplantation
Glicklich, D., & Vohra, P. (2014) · Cardiology in Review · doi:10.1097/crd.0000000000000012 · Cited by 49 · see citing works
“bleeding and bleeding after invasive procedures such as angiography or biopsy.(71,72) Therefore, it is controversial whether patients with ESRD and Afib should receive chronic anticoagulant therapy with”
BackgroundAnticoagulation in chronic kidney disease: current status and future perspectives
Jones, A. P., Swan, D., Lisman, T., Barnes, G. D., & Thachil, J. V. (2023) · Journal of Thrombosis and Haemostasis · doi:10.1016/j.jtha.2023.09.020 · Cited by 48 · see citing works
Anticoagulants and acute kidney injury: clinical and pathology considerations
Brodsky, S. V. (2014) · Kidney Research and Clinical Practice · doi:10.1016/j.krcp.2014.11.001 · Cited by 48 · see citing works
“They reported that patients with severe CKD were at higher risk for both over-anticoagulation and major hemorrhage, as compared with patients with mild or moderate CKD. Chan et al [15] reported that warfarin therapy is associated with higher mortality among hemodialysis patients than in non–end-stage renal disease (ES…”
BackgroundOral anticoagulation in patients with chronic kidney disease
Malhotra, K., Ishfaq, M. F., Goyal, N., Katsanos, A. H., Parissis, J., Alexandrov, A. W., Alexandrov, A. V., & Tsivgoulis, G. K. (2019) · Neurology · doi:10.1212/wnl.0000000000007534 · Cited by 48 · see citing works
Sailing between Scylla and Charybdis: oral long-term anticoagulation in dialysis patients
Krüger, T., Brandenburg, V. M., Schlieper, G., Marx, N., & Floege, J. (2012) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfs485 · Cited by 46 · see citing works
“• A retrospective analysis of 1671 incident HD patients with preexisting atrial fibrillation investigated the association of ASS or clopidogrel versus warfarin versus no therapy with stroke and death [31].”
BackgroundWarfarin Use in Patients With Atrial Fibrillation Undergoing Hemodialysis
Yoon, C.-Y., Noh, J., Jhee, J. H., Chang, T. I., Kang, E. W., Kee, Y. K., Kim, H., Park, S., Yun, H., Jung, S.-Y., et al. (2017) · Stroke · doi:10.1161/strokeaha.117.017114 · Cited by 46 · see citing works
Chen, J., Lin, L., Yang, Y., Hwang, J., Chen, P., & Lin, J.-L. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.09.140 · Cited by 45 · see citing works
Morbidity and treatment in patients with atrial fibrillation and chronic kidney disease
Reinecke, H., Näbauer, M., Gerth, A., Limbourg, T., Treszl, A., Engelbertz, C. M., Eckardt, L., Kirchhof, P. F., Wegscheider, K., Ravens, U., et al. (2014) · Kidney International · doi:10.1038/ki.2014.195 · Cited by 45 · see citing works
Akimoto, T., Ito, C., Kato, M., Ogura, M., Muto, S., & Kusano, E. (2011) · Medical Hypotheses · doi:10.1016/j.mehy.2011.06.044 · Cited by 44 · see citing works
Coumarins and survival in incident dialysis patients
Knöll, F., Sturm, G., Lamina, C., Zitt, E., Lins, F., Freistätter, O., Kronenberg, F., Lhotta, K., & Neyer, U. (2011) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfr341 · Cited by 44 · see citing works
“Increased risk for haemorrhages [5] and the potential to accelerate vascular calcification as an effect of coumarins on vitamin K-dependent calcification inhibitor proteins [6] are put forward as main arguments against oral anticoagulation in dialysis patients.”
Background
- Authors
- Chan, K. E., Lazarus, J. M., Thadhani, R., & Hakim, R. M.
- Affiliations
- Fresenius Medical Care (United States) (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Chan, Kevin E.
- Lazarus, J. Michael
- Hakim, Raymond M.
- Venue
- Journal of the American Society of Nephrology
- Published
- 2009-10
- Volume
- 20
- Issue
- 10
- Pages
- 2223-2233
- ISSN
- 1046-6673 (ISSN-L)
- PMC
- PMC2754104
- OpenAlex
- W2137138584
- Cited by
- 431
- References
- 86
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 12 · 2023: 17 · 2022: 15 · 2021: 20 · 2020: 23 · 2019: 21 · 2018: 38 · 2017: 40 · 2016: 40 · 2015: 43 · 2014: 34 · 2013: 35 · 2012: 29
- FWCI
- 16.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- warfarin, stroke risk, hemodialysis, atrial fibrillation, end-stage renal disease, clopidogrel, aspirin, INR monitoring, anticoagulation, mortality, hospitalization
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Female, Renal Dialysis, Hospitalization, Humans, Kidney Failure, Chronic, Male, Regression Analysis, Retrospective Studies, Risk, Warfarin, Cohort Studies, International Normalized Ratio, Stroke
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