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Warfarin Use and the Risk for Stroke and Bleeding in Patients With Atrial Fibrillation Undergoing Dialysis
Study Questions:
What is the association between warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation (AF) undergoing dialysis?
Methods:
This was a population-based retrospective cohort study of Canadian patients ages 65 years and older admitted to a hospital with a primary or secondary diagnosis of AF. Multivariable logistic regression analysis was used to characterize the association between warfarin use and the risk for stroke and bleeding in dialysis and nondialysis patients.
Results:
There were 1,626 dialysis patients, and 204,210 nondialysis patients. In adjusted analyses, warfarin use in dialysis patients (when compared to no-warfarin use) was associated with a lower risk for stroke (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.78-1.67), but was associated with a 44% higher risk for bleeding (adjusted HR, 1.44; 95% CI, 1.13-1.85).
Conclusions:
In dialysis patients with AF, warfarin use, compared to no-warfarin use, did not reduce stroke risk in this retrospective cohort study, but was associated with a higher bleeding risk.
Perspective:
The findings from this large retrospective cohort study corroborate data from current and previous observational studies, providing mounting evidence against the use of anticoagulation in AF patients undergoing dialysis. Although randomized controlled trial data would be helpful to more definitively guide clinical practice, there is currently a lack of evidence to offer compelling reasons for anticoagulation in the population of AF patients on dialysis.
Keywords: Renal Dialysis, Risk, Blood Coagulation, Stroke, Warfarin, Canada, Antimicrobial Cationic Peptides, Hemorrhage
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