Warfarin increases bleeding risk in patients with end-stage CKD
The use of warfarin to treat atrial fibrillation may have an unfavorable risk–benefit ratio in patients with end-stage chronic kidney disease, according to research published in Chest.
“The current meta-analysis suggests that warfarin use is beneficial in patients with non-end-stage [chronic kidney disease] but may be harmful in patients with end-stage [chronic kidney disease] due to the increased risk of major bleeding,” the researchers wrote.
Khagendra Dahal, MD, clinical assistant professor of medicine at the University of New England LRGHealthcare in Laconia, New Hampshire, and colleagues searched various electronic databases for observational studies evaluating the use of warfarin in patients with AF and chronic kidney disease (CKD), performing manual searches for relevant references.
The researchers considered 13 publications from 11 cohorts involving more than 48,500 patients and more than 11,600 warfarin users; six studies were retrospective and five were prospective.
The investigators used a random-effects model to estimate pooled HR. With patients divided into groups based on non-end-stage CKD and end-stage CKD (on renal replacement therapy), the team conducted separate analyses.
Patients with AF and non-end-stage CKD receiving warfarin demonstrated decreased risk for ischemic stroke/thromboembolism (HR = 0.7; 95% CI, 0.54-0.89) and mortality (HR = 0.65; 95% CI, 0.59-0.72); no effect was seen on major bleeding (HR = 1.15; 95% CI, 0.88-1.49).
Although warfarin did not appear to affect the risks for stroke (HR = 1.12; 95% CI, 0.69-1.82) or mortality (HR = 0.96; 95% CI, 0.81-1.13) among patients with AF and end-stage CKD, the risks for major bleeding were elevated (HR = 1.3; 95% CI, 1.08-1.56).
“Our meta-analysis provides the most comprehensive review to date on the use of warfarin in patients with CKD,” the researchers wrote. “[An] adequately powered randomized controlled trial should confirm these finding and settle this issue once and for all,” – by Allegra Tiver
Disclosure: Dahal reports no relevant financial disclosures.