Warfarin in atrial fibrillation patients with moderate chronic kidney disease
Open accessAbstract
BACKGROUND AND OBJECTIVES: The efficacy of adjusted-dose warfarin for prevention of stroke in atrial fibrillation patients with stage 3 chronic kidney disease (CKD) is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients with stage 3 CKD participating in the Stroke Prevention in Atrial Fibrillation 3 trials were assessed to determine the effect of warfarin anticoagulation on stroke and major hemorrhage, and whether CKD status independently contributed to stroke risk. High-risk participants (n = 1044) in the randomized trial were assigned to adjusted-dose warfarin (target international normalized ratio 2 to 3) versus aspirin (325 mg) plus fixed, low-dose warfarin (subsequently shown to be equivalent to aspirin alone). Low-risk participants (n = 892) all received 325 mg aspirin daily. The primary outcome was ischemic stroke (96%) or systemic embolism (4%). RESULTS: Among the 1936 participants in the two trials, 42% (n = 805) had stage 3 CKD at entry. Considering the 1314 patients not assigned to adjusted-dose warfarin, the primary event rate was double among those with stage 3 CKD (hazard ratio 2.0, 95% CI 1.2, 3.3) versus those with a higher estimated GFR (eGFR). Among the 516 participants with stage 3 CKD included in the randomized trial, ischemic stroke/systemic embolism was reduced 76% (95% CI 42, 90; P < 0.001) by adjusted-dose warfarin compared with aspirin/low-dose warfarin; there was no difference in major hemorrhage (5 patients versus 6 patients, respectively). CONCLUSIONS: Among atrial fibrillation patients participating in the Stroke Prevention in Atrial Fibrillation III trials, stage 3 CKD was associated with higher rates of ischemic stroke/systemic embolism. Adjusted-dose warfarin markedly reduced ischemic stroke/systemic embolism in high-risk atrial fibrillation patients with stage 3 CKD.
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Anticoagulation can be safely used in AF patients with moderate or moderate-to-severe CKD (glomerular filtration rate ≥ 15 mL/min).
“Anticoagulation can be safely used in AF patients with moderate or moderate-to-severe CKD (glomerular filtration rate [GFR] ≥ 15 mL/min):”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [412]
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- Authors
- Hart, R. G., Pearce, L. A., Asinger, R. W., & Herzog, C. A.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Hennepin County Medical Center (US)
- Corresponding author
- Hart, Robert G.
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2011-11
- Volume
- 6
- Issue
- 11
- Pages
- 2599-2604
- ISSN
- 1555-9041 (ISSN-L)
- PMC
- PMC3359566
- OpenAlex
- W2130977972
- Cited by
- 204
- References
- 28
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 13 · 2022: 3 · 2021: 7 · 2020: 11 · 2019: 14 · 2018: 21 · 2017: 14 · 2016: 19 · 2015: 21 · 2014: 34 · 2013: 22 · 2012: 10
- FWCI
- 14.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01ns024224-11)
- National Institute of Neurological Disorders and Stroke (R01NS24224)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- warfarin, atrial fibrillation, chronic kidney disease stage 3, stroke prevention, ischemic stroke, systemic embolism, major bleeding, aspirin, anticoagulation, estimated glomerular filtration rate
- MeSH terms
- Aged, Anticoagulants, Aspirin, Atrial Fibrillation, Blood Coagulation, Canada, Chronic Disease, Drug Therapy, Combination, Female, Hemorrhage, Humans, Kidney Diseases, Male, Platelet Aggregation Inhibitors, Risk Factors, Severity of Illness Index, Time Factors, United States, Warfarin, Chi-Square Distribution, Proportional Hazards Models, Treatment Outcome, Risk Assessment, International Normalized Ratio, Stroke, Kaplan-Meier Estimate
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