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Warfarin Use in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Nationwide Population-Based Study

 Chang-Yun Yoon  ;  Juhwan Noh  ;  Jong Hyun Jhee  ;  Tae Ik Chang  ;  Ea Wha Kang  ;  Youn Kyung Kee  ;  Hyoungnae Kim  ;  Seohyun Park  ;  Hae-Ryong Yun  ;  Su-Young Jung  ;  Hyung Jung Oh  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Shin-Wook Kang  ;  Changsoo Kim  ;  Tae-Hyun Yoo 
 STROKE, Vol.48(9) : 2472-2479, 2017 
Journal Title
Issue Date
Aged ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy* ; Databases, Factual ; Female ; Hemorrhage/chemically induced ; Humans ; Intracranial Hemorrhages/chemically induced ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy* ; Male ; Middle Aged ; Propensity Score ; Proportional Hazards Models ; Renal Dialysis* ; Republic of Korea ; Stroke/etiology ; Stroke/prevention & control* ; Thromboembolism/epidemiology ; Warfarin/therapeutic use*
atrial fibrillation ; confidence intervals ; dialysis ; end-stage renal disease ; propensity score ; stroke ; warfarin
BACKGROUND AND PURPOSE: The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. METHODS: Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. RESULTS: Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2%) were men, and 2921 (29.3%) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8%) and 227 (2.3%) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95% confidence interval, 1.09-1.91; P=0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95% confidence interval, 1.10-2.22; P=0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95% confidence interval, 0.78-1.15; P=0.569) or overall cohort (hazard ratio, 1.06; 95% confidence interval, 0.90-1.26; P=0.470). CONCLUSIONS: Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kee, Youn Kyung(기연경)
Kim, Chang Soo(김창수) ORCID logo https://orcid.org/0000-0002-5940-5649
Kim, Hyoung Rae(김형래)
Noh, Juhwan(노주환) ORCID logo https://orcid.org/0000-0003-0657-0082
Park, Seo Hyun(박서현)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Jung, Su Young(정수영)
Jhee, Jong Hyun(지종현)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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