title: Warfarin use and incidence of stroke in Japanese hemodialysis patients with atrial fibrillation.
abstract: Atrial fibrillation (AF) is one of the major risk factor for ischemic stroke, and oral anticoagulation is generally indicated for prevention of stroke. However, the utility of oral anticoagulation for AF in dialysis patients remains controversial. In this single-center, retrospective, observational study, data from 1120 patients on maintenance hemodialysis were analyzed. Baseline medical data were collected from dialysis records including age, gender, the cause of end-stage renal disease, dialysis vintage, and comorbidities. We evaluated outcomes including stroke, major hemorrhage, and death. A total of 106 (11.4 %) patients had AF. After exclusion criteria were applied, 84 patients had analyzable data. Warfarin was prescribed in 30 (35.7 %) of these patients. The remaining 54 patients were classified as the non-warfarin group. CHADS2 score was not significantly different between the warfarin and non-warfarin group. During the mean 47 months of follow up, 7 strokes occurred. However, warfarin use was not associated with the risk for stroke [hazard ratio (HR) 1.07; 95 % confidence interval (CI) 0.20-5.74]. Kaplan-Meier analysis showed no statistically significant difference in the overall survival, stroke-free survival or bleeding-free survival between the warfarin and non-warfarin group. AF is common in Japanese dialysis patients. Despite a certain prevalence of oral anticoagulation, the present study demonstrated neither beneficial nor detrimental effects. A large randomized controlled trial should be considered.
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. yodo@nms.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yodogawa
authors.affiliation: Divisions of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Mii
authors.affiliation: Divisions of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Fukui
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Yu-Ki
authors.initials: YK
authors.lastname: Iwasaki
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Meiso
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Divisions of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyauchi
authors.affiliation: Divisions of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tsuruoka
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; Hemodialysis; Stroke; Warfarin