Korean J Med.  2019 Apr;94(2):191-199. 10.3904/kjm.2019.94.2.191.

Comparison of the Efficacy and Safety of Warfarin and Antiplatelet Therapy in Patients with Atrial Fibrillation and End-Stage Renal Disease

• Han D
• Uhm JS
• Park JT
• Kim TH
• Joung B
• Yoo TH
• Pak HN
• Kang SW
• Lee MH

• KMID: 2446974
• DOI: http://doi.org/10.3904/kjm.2019.94.2.191

Abstract

BACKGROUND/AIMS
The optimal strategy for anticoagulation treatment in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has not been established. We evaluated the efficacy and bleeding risk of warfarin and antiplatelet agents in patients with AF and ESRD.
METHODS
We retrospectively reviewed the medical records of 256 patients with AF and ESRD and included 158 patients (age, 63.7 ± 12.2 years; male sex, n = 103) with a CHA2DS2-VASc score ≥ 1 who were taking warfarin (n = 53) or an antiplatelet agent (n = 105).
RESULTS
During the follow-up period (31.0 ± 29.4 months), 10 ischemic events and 29 major bleeding events occurred. The thromboembolic event rate did not significantly differ between the warfarin and antiplatelet groups (1.9% and 8.6%, respectively; p = 0.166). However, the rate of major bleeding events was significantly higher in the warfarin group than it was in the antiplatelet group (32.1% and 11.4%, respectively; p = 0.002). Cox's regression analysis indicated that warfarin was related to an increased risk of major bleeding events (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.60-7.36; p = 0.001). Conversely, warfarin was not related to a decreased risk of thromboembolic events (HR, 0.34; 95% CI, 0.04-2.70; p = 0.306).
CONCLUSIONS
In patients with AF and ESRD, warfarin use was associated with an increased risk of bleeding events, compared with antiplatelet agents.

Keyword

Atrial fibrillation; Kidney failure, Chronic; Anticoagulants; Warfarin

MeSH Terms

Anticoagulants
Atrial Fibrillation*
Follow-Up Studies
Hemorrhage
Humans
Kidney Failure, Chronic*
Male
Medical Records
Platelet Aggregation Inhibitors
Retrospective Studies
Warfarin*
Anticoagulants
Platelet Aggregation Inhibitors
Warfarin