Warfarin use in critically ill CKD patients was associated with lower in-hospital mortality (8.8%, aOR 0.345) than DOACs or heparin, despite a higher incidence of AKI (70.0%, aOR 1.250).
Does warfarin alter the risk of AKI and mortality compared to DOACs or heparin in critically ill patients with CKD?
In critically ill patients with CKD, warfarin use was associated with a higher incidence of AKI but paradoxically lower in-hospital mortality compared to DOACs and heparin.
Absolute Event Rate: 0% vs 0%
Introduction: Anticoagulation management in ICU patients with chronic kidney disease (CKD) presents competing risks of bleeding and thrombosis, with limited evidence comparing different strategies.We aimed to compare the incidence of acute kidney injury (AKI) and mortality across anticoagulation approaches in critically ill CKD patients.Methods: We conducted a retrospective cohort study using the MIMIC-IV database, including adult ICU patients with pre-existing CKD (stages 2-5, eGFR <90 mL/min/1.73m 2 ) receiving anticoagulation between 2008-2022.Patients were classified by primary anticoagulant: warfarin, direct oral anticoagulants (DOACs), or heparin/low-molecular-weight heparin.The primary outcome was AKI by KDIGO criteria.Secondary outcomes included major bleeding, in-hospital mortality, and composite endpoints.We performed multivariable logistic regression and propensity score analysis with inverse probability weighting.Results: Among 2,671 patients, 704 (26.4%) received warfarin, 340 (12.7%)DOACs, and 1,627 (60.9%) heparin.Despite the highest AKI incidence (70.0%vs 60.6% DOACs and 62.8% heparin, p<0.001; adjusted OR 1.250, 95% CI: 1.021-1.530,p=0.031), warfarin unexpectedly demonstrated the lowest in-hospital mortality (8.8% vs 11.8% DOACs and 21.9% heparin, p<0.001; adjusted OR 0.345, 95% CI: 0.259-0.459,p<0.001).Major bleeding was highest with DOACs (39.1%) compared to warfarin (25.7%) and heparin (23.0%, p<0.001).AKI recovery rates were similar across groups (warfarin 64.5%, DOACs 63.6%, heparin 65.5%, p=0.843).Among warfarin users, optimal INR control (2.5-3.0) was associated with the lowest AKI incidence (55.4%), while subtherapeutic INR (<2.0) corresponded to the highest rate (73.9%).
Biswas et al. (Wed,) reported a other. Warfarin use in critically ill CKD patients was associated with lower in-hospital mortality (8.8%, aOR 0.345) than DOACs or heparin, despite a higher incidence of AKI (70.0%, aOR 1.250).