Warfarin use was not associated with a lower rate of all-cause death (HR 0.782; 95% CI 0.494-1.237; P=0.293) in Indonesian hemodialysis patients with atrial fibrillation.
Cohort (n=88)
Does warfarin reduce death or stroke in end-stage renal disease patients with atrial fibrillation undergoing hemodialysis?
In Indonesian hemodialysis patients with atrial fibrillation, warfarin use was not associated with reduced mortality or stroke, and therapeutic anticoagulation levels were poorly maintained.
Effect estimate: HR 0.782 (95% CI 0.494-1.237)
p-value: p=0.293
The data about the efficacy and safety of warfarin usage in atrial fibrillation (AF) in hemodialysis patients is still limited, especially in the Asia population. The population of this study was end-stage renal disease patients with AF who underwent hemodialysis. The design of the study was a retrospective observational cohort that collected the patient data from 2016 to 2019. The Cox regression model was applied to assess the effect of warfarin on the outcomes. We conducted a survival analysis by comparing Kaplan-Meier curves using the log-rank test. We also measured the time in therapeutic range as a quality indicator of warfarin usage. Among 444 hemodialysis patients, 126 patients with AF matched the inclusion criteria, 88 patients completely followed up. Half patients used warfarin. The mean age was 52.2 ± 12.97 years, the mean follow-up duration was 11 ± 10 months. We observed all-cause death in 86.4% of patients, ischemic stroke in 10.2%, and hemorrhagic stroke in 2.3% of patients. There were no significant differences in all-cause death, ischemic stroke, and hemorrhagic stroke. Warfarin use was not associated with a lower rate for death (HR 0.782; 95% CI, 0.494-1.237, P = 0.293) or ischemic stroke (HR 0.435; 95% CI, 0.103-1.846, P = 0.259) or hemorrhagic stroke (HR 0.564; 95% CI, 0.034-9.386, P = 0.689). None of the patients reach the time in the therapeutic range >65%. Our findings suggest that warfarin has no association with mortality, ischemic stroke, and hemorrhagic stroke events rate in atrial fibrillation patients who underwent hemodialysis in the Indonesian population.
Akbar et al. (Sat,) conducted a cohort in Atrial fibrillation and end-stage renal disease on hemodialysis (n=88). Warfarin vs. No warfarin was evaluated on All-cause death (HR 0.782, 95% CI 0.494-1.237, p=0.293). Warfarin use was not associated with a lower rate of all-cause death (HR 0.782; 95% CI 0.494-1.237; P=0.293) in Indonesian hemodialysis patients with atrial fibrillation.