Warfarin use in CKD associated with increased risk for ischemic stroke
SAN DIEGO — Patients with late-stage chronic kidney disease receiving warfarin treatment were more likely to experience cerebrovascular accidents, such as ischemic stroke or transient ischemic attack, according to data presented at ASN Kidney Week 2018.
“Atrial fibrillation is a high thromboembolic state,” Manyoo Agarwal, MD, from the University of Tennessee Health Science Center, told Healio Nephrology. “If you look at the global atrial fibrillation population, the use of anticoagulation is to prevent strokes in this patient population. All of the studies conducted never included the late-stage CKD or end-stage renal disease population in randomized clinical trials, so there is no robust data for prescribing anticoagulation associated with the clinical outcomes for this patient population.”
“Because there is limited data, we conducted the study to examine how use of warfarin impacts the clinical outcomes of incident atrial fibrillation population who have late stage CKD but are transitioning to end stage renal disease,” he continued.
Agarwal and colleagues evaluated data from a national cohort of veterans from the United States (n = 23,201; mean age, 77 years; 95% men; 13% black) with incident end stage renal disease who developed atrial fibrillation before starting renal replacement therapy. The researchers evaluated whether warfarin therapy after atrial fibrillation is associated with cerebrovascular accidents, including ischemic stroke and transient ischemic attack, as well as hemorrhagic strokes, post-dialysis fatal bleeding and all-cause mortality. The researchers adjusted for demographic characteristics and comorbidities.
Most participants were hypertensive (99%), diabetic (79%) and had histories of ischemic heart disease (88%), congestive heart failure (88%) and cerebrovascular accidents (64%). Nearly a quarter (24.3%) of participants received warfarin therapy.
Results showed that participants exposed to warfarin had a higher risk for all outcomes aside from all-cause mortality than those not exposed to the drug. After multivariate adjustment, the differences in outcomes remained significant except for fatal bleeding events.
“Prescription of warfarin during the pre-dialysis period is associated with higher ischemic stroke events, ischemic related hospitalizations and major bleeding events in the late-stage CKD population who had atrial fibrillation,” Agarwal said. – by Alaina Tedesco
Agarwal M, et al. Abstract: TH-PO426. Presented at: ASN Kidney Week 2018; Oct. 23-28, 2018; San Diego.
Disclosure: Healio Nephrology was unable to confirm relevant financial disclosures at the time of publication.