Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis: A Nationwide Population-Based Study

Chang Yun Yoon, Juhwan Noh, Jong Hyun Jhee, Tae Ik Chang, Ea Wha Kang, Youn Kyung Kee, Hyoungnae Kim, Seohyun Park, Hae Ryong Yun, Su Young Jung, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Shin Wook Kang, Changsoo Kim, Tae Hyun Yoo

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and Purpose - The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. Methods - Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. Results - Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2%) were men, and 2921 (29.3%) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8%) and 227 (2.3%) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95% confidence interval, 1.09-1.91; P=0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95% confidence interval, 1.10-2.22; P=0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95% confidence interval, 0.78-1.15; P=0.569) or overall cohort (hazard ratio, 1.06; 95% confidence interval, 0.90-1.26; P=0.470). Conclusions - Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications.

Original languageEnglish
Pages (from-to)2472-2479
Number of pages8
JournalStroke
Volume48
Issue number9
DOIs
Publication statusPublished - 2017 Sep 1

Fingerprint

Warfarin
Atrial Fibrillation
Renal Dialysis
Population
Stroke
Confidence Intervals
Propensity Score
Proportional Hazards Models
Information Services
Social Security
National Health Programs
Health Insurance
Registries
Dialysis
Databases

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Yoon, Chang Yun ; Noh, Juhwan ; Jhee, Jong Hyun ; Chang, Tae Ik ; Kang, Ea Wha ; Kee, Youn Kyung ; Kim, Hyoungnae ; Park, Seohyun ; Yun, Hae Ryong ; Jung, Su Young ; Oh, Hyung Jung ; Park, Jung Tak ; Han, Seung Hyeok ; Kang, Shin Wook ; Kim, Changsoo ; Yoo, Tae Hyun. / Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis : A Nationwide Population-Based Study. In: Stroke. 2017 ; Vol. 48, No. 9. pp. 2472-2479.
@article{cf0061fe40c2427296c87d412a161f7c,
title = "Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis: A Nationwide Population-Based Study",
abstract = "Background and Purpose - The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. Methods - Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. Results - Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2{\%}) were men, and 2921 (29.3{\%}) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8{\%}) and 227 (2.3{\%}) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95{\%} confidence interval, 1.09-1.91; P=0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95{\%} confidence interval, 1.10-2.22; P=0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95{\%} confidence interval, 0.78-1.15; P=0.569) or overall cohort (hazard ratio, 1.06; 95{\%} confidence interval, 0.90-1.26; P=0.470). Conclusions - Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications.",
author = "Yoon, {Chang Yun} and Juhwan Noh and Jhee, {Jong Hyun} and Chang, {Tae Ik} and Kang, {Ea Wha} and Kee, {Youn Kyung} and Hyoungnae Kim and Seohyun Park and Yun, {Hae Ryong} and Jung, {Su Young} and Oh, {Hyung Jung} and Park, {Jung Tak} and Han, {Seung Hyeok} and Kang, {Shin Wook} and Changsoo Kim and Yoo, {Tae Hyun}",
year = "2017",
month = "9",
day = "1",
doi = "10.1161/STROKEAHA.117.017114",
language = "English",
volume = "48",
pages = "2472--2479",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

Yoon, CY, Noh, J, Jhee, JH, Chang, TI, Kang, EW, Kee, YK, Kim, H, Park, S, Yun, HR, Jung, SY, Oh, HJ, Park, JT, Han, SH, Kang, SW, Kim, C & Yoo, TH 2017, 'Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis: A Nationwide Population-Based Study', Stroke, vol. 48, no. 9, pp. 2472-2479. https://doi.org/10.1161/STROKEAHA.117.017114

Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis : A Nationwide Population-Based Study. / Yoon, Chang Yun; Noh, Juhwan; Jhee, Jong Hyun; Chang, Tae Ik; Kang, Ea Wha; Kee, Youn Kyung; Kim, Hyoungnae; Park, Seohyun; Yun, Hae Ryong; Jung, Su Young; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Kang, Shin Wook; Kim, Changsoo; Yoo, Tae Hyun.

In: Stroke, Vol. 48, No. 9, 01.09.2017, p. 2472-2479.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis

T2 - A Nationwide Population-Based Study

AU - Yoon, Chang Yun

AU - Noh, Juhwan

AU - Jhee, Jong Hyun

AU - Chang, Tae Ik

AU - Kang, Ea Wha

AU - Kee, Youn Kyung

AU - Kim, Hyoungnae

AU - Park, Seohyun

AU - Yun, Hae Ryong

AU - Jung, Su Young

AU - Oh, Hyung Jung

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Kang, Shin Wook

AU - Kim, Changsoo

AU - Yoo, Tae Hyun

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background and Purpose - The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. Methods - Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. Results - Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2%) were men, and 2921 (29.3%) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8%) and 227 (2.3%) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95% confidence interval, 1.09-1.91; P=0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95% confidence interval, 1.10-2.22; P=0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95% confidence interval, 0.78-1.15; P=0.569) or overall cohort (hazard ratio, 1.06; 95% confidence interval, 0.90-1.26; P=0.470). Conclusions - Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications.

AB - Background and Purpose - The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. Methods - Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. Results - Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2%) were men, and 2921 (29.3%) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8%) and 227 (2.3%) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95% confidence interval, 1.09-1.91; P=0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95% confidence interval, 1.10-2.22; P=0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95% confidence interval, 0.78-1.15; P=0.569) or overall cohort (hazard ratio, 1.06; 95% confidence interval, 0.90-1.26; P=0.470). Conclusions - Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications.

UR - http://www.scopus.com/inward/record.url?scp=85030441901&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030441901&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.117.017114

DO - 10.1161/STROKEAHA.117.017114

M3 - Article

C2 - 28801476

AN - SCOPUS:85030441901

VL - 48

SP - 2472

EP - 2479

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -