Original InvestigationDialysisOutcomes After Warfarin Initiation in a Cohort of Hemodialysis Patients With Newly Diagnosed Atrial Fibrillation
Section snippets
Study Population
From the US Renal Data System (USRDS), we identified all hemodialysis patients who had a new diagnosis of AF in July 2007 to December 2011 based on 1 inpatient or 2 outpatient diagnosis codes within 30 days of each other indicating AF or atrial flutter (International Classification of Diseases, Ninth Revision codes 427.3x; Fig 1). We excluded those with a history of valvular disease associated with AF (Table S1, available as online supplementary material).11 For patients with AF diagnosed from
Patient Characteristics
We identified 12,284 patients undergoing hemodialysis who had AF newly diagnosed, 15% of whom initiated warfarin therapy (Fig 1). Users and nonusers differed only slightly, and most of these differences were related to risk factors for bleeding (Table 1). Notably, 90% of both groups met CHADS2 criteria for oral anticoagulation for patients with AF (score ≥ 2), although a larger proportion of nonusers (70% vs 63%) had a HAS-BLED score ≥ 3, a situation in which anticoagulation is not recommended
Discussion
The benefits of oral anticoagulation for AF have been demonstrated in a number of randomized trials22; however, patients with ESRD were excluded from these studies. Therefore, whether the benefits of oral anticoagulation extend to patients undergoing hemodialysis is unclear23, 24, 25 because they have a substantially higher risk of stroke compared with the general population, but also a higher risk of bleeding.13, 23, 24, 25, 26 This clinical equipoise was reflected in a survey of Canadian
Acknowledgements
Data reported here were supplied by the USRDS. Interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government.
Support: This work was supported by grants F32DK096765 (Dr Shen), K23DK095914 (Dr Chang), and R21DK077336 and R01DK095024 (Dr Winkelmayer) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD. The Stanford Nephrology fellowship program was
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