Cited by 431Atrial Fibrillation Management and OutcomesDialysis and Renal Disease ManagementAcute Ischemic Stroke Management

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Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

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Chan, Kevin E., Lazarus, J. Michael, Thadhani, Ravi, Hakim, Raymond M.·2009·Journal of the American Society of Nephrology

DOI 10.1681/asn.2009030319PMC PMC2754104

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Abstract

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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See all 431

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.
ORCID: Lazarus, J. Michael
Thadhani, Ravi
Hakim, Raymond M.
Venue: Journal of the American Society of Nephrology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-10
Volume: 20
Issue: 10
Pages: 2223-2233
ISSN: 1046-6673 (ISSN-L)
DOI: 10.1681/asn.2009030319
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 › Clinical Neurology › 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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Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

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