Key result
Warfarin use in hemodialysis patients with AF is linked to ~82% higher CHF risk.
Why the study?
Does warfarin increase the risk of cardiovascular events and death in chronic hemodialysis patients with atrial fibrillation?
Cohort
Does warfarin increase the risk of cardiovascular events and death in chronic hemodialysis patients with atrial fibrillation?
Effect estimate: HR 1.82 (95% CI 1.29-2.58)
p-value: p=<0.01
In hemodialysis patients with atrial fibrillation, warfarin use is associated with an increased risk of congestive heart failure, peripheral artery occlusive disease, and aortic valve stenosis without reducing stroke or mortality.
Warfarin-associated higher CHF risk in HD-AF patients should not change practice; leaves open need for RCTs to confirm causality.
BACKGROUND: The effect of warfarin on the risk of cardiovascular (CV) disease is unknown among chronic hemodialysis patients with atrial fibrillation (HD-AF). METHODS: -VASc score ≥ 2 were divided into warfarin users and nonusers and followed-up for CV events and death. RESULTS: Warfarin treatment in HD-AF patients with AF preceding HD was associated with higher risks of developing congestive heart failure [hazard ratio (HR)=1.82, 95% confidence interval (CI)=1.29-2.58, p<0.01], peripheral artery occlusive disease (HR=3.42, 95% CI=1.86-6.31, p<0.01), and aortic valve stenosis (HR=3.20, 95% CI=1.02-9.98, p<0.05). Warfarin users were not associated with risks of ischemic or hemorrhagic stroke and all-cause mortality as compared to nonusers. CONCLUSION: Warfarin may be associated with vascular calcification, increasing the risks of congestive heart failure and peripheral artery occlusive disease among HD-AF patients.
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Lee et al. (2017) conducted a cohort in chronic hemodialysis patients with atrial fibrillation. Warfarin vs. Nonusers was evaluated on congestive heart failure (HR 1.82, 95% CI 1.29-2.58, p=<0.01). Warfarin use in hemodialysis patients with atrial fibrillation was associated with a higher risk of congestive heart failure (HR 1.82; 95% CI 1.29-2.58; p<0.01).
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