title: Association of warfarin with congestive heart failure and peripheral artery occlusive disease in hemodialysis patients with atrial fibrillation.
abstract: BACKGROUND
  The effect of warfarin on the risk of cardiovascular (CV) disease is unknown among chronic hemodialysis patients with atrial fibrillation (HD-AF).
  
  
  METHODS
  Population-based propensity score and prescription time-distribution matched cohort study including 6719 HD-AF patients with CHA2DS2-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.
  
  
  CONCLUSIONS
  Warfarin may be associated with vascular calcification, increasing the risks of congestive heart failure and peripheral artery occlusive disease among HD-AF patients.
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.affiliation: Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Taipei, Taiwan, ROC.
authors.forename: Jin-Sin
authors.initials: JS
authors.lastname: Liu
authors.affiliation: Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Taipei, Taiwan, ROC.
authors.forename: Chi-Ting
authors.initials: CT
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Chen
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yao-Ping
authors.initials: YP
authors.lastname: Lin
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: dctarng@vghtpe.gov.tw.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D001281:Atrial Fibrillation / Q000150:complications*; D002545:Brain Ischemia / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology; D061205:Vascular Calcification / Q000209:etiology; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: atrial fibrillation; hemodialysis; warfarin