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. 2024 Apr 20;13(8):2404.
doi: 10.3390/jcm13082404.

Clinical Impact of the Use of Warfarin in Patients with Atrial Fibrillation Undergoing Maintenance Hemodialysis

Seok Hui Kang  1 , Gui Ok Kim  2 , Bo Yeon Kim  3 , Eun Jung Son  2 , Jun Young Do  1
Affiliations

Clinical Impact of the Use of Warfarin in Patients with Atrial Fibrillation Undergoing Maintenance Hemodialysis

Seok Hui Kang et al. J Clin Med. .

Abstract

Background: We evaluated the impact of warfarin use on the clinical outcomes of patients with atrial fibrillation who were undergoing hemodialysis (HD). Methods: A retrospective analysis was conducted utilizing data from patients undergoing maintenance HD who participated in HD quality assessment programs. Patients who were assigned the diagnostic code for atrial fibrillation (n = 4829) were included and divided into two groups based on the use of warfarin: No group (no warfarin prescriptions (n = 4009)), and Warfarin group (warfarin prescriptions (n = 820)). Results: Cox regression analyses revealed that the hazard ratio for all-cause mortality in the Warfarin group was 1.15 (p = 0.005) in univariate analysis and 1.11 (p = 0.047) in multivariable analysis compared to that of the No group. Hemorrhagic stroke was significantly associated with warfarin use, but no significant association between the use of warfarin and ischemic stroke or cardiovascular events was observed. The subgroup results demonstrated similar trends. Conclusions: Warfarin use is associated with a higher risk of all-cause mortality and hemorrhagic stroke, and has a neutral effect on ischemic stroke and cardiovascular events in patients with atrial fibrillation who are undergoing HD, compared to those who are not using warfarin.

Keywords: atrial fibrillation; hemodialysis; survival; warfarin.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for all-cause mortality, hemorrhagic stroke, ischemic stroke, and cardiovascular events according to the use of warfarin. (A) All-cause mortality; (B) Hemorrhagic stroke; (C) Ischemic stroke; (D) Cardiovascular events. Abbreviations: CVE, cardiovascular events; Hstroke, hemorrhagic stroke; Istroke, ischemic stroke.
Figure 2
Figure 2
Association between the use of warfarin and clinical outcomes using univariate Cox regression analyses based on subgroups. (A) All-cause mortality; (B) Ischemic stroke; (C) Hemorrhagic stroke; (D) Cardiovascular events. A low CHA2DS2-VASC score was <2 in females and <3 in males, and a high CHA2DS2-VASC score was ≥2 in females and ≥3 in males. The values represent the HR of the Warfarin group compared to the No group. Abbreviations: CI, confidence interval; HR, hazard ratio.
Figure 3
Figure 3
Association between the use of warfarin and clinical outcomes using multivariable Cox regression analyses based on subgroups. (A) All-cause mortality; (B) Ischemic stroke; (C) Hemorrhagic stroke; (D) Cardiovascular events. A low CHA2DS2-VASC score was <2 in females and <3 in males, and a high CHA2DS2-VASC score was ≥2 in females and ≥3 in males. The values represent the HR of the Warfarin group compared to the No group. Abbreviations: CI, confidence interval; HR, hazard ratio.
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