Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis
Background There is limited information on the risks and benefits of anticoagulation in patients with atrial fibrillation receiving peritoneal dialysis. Objective The aim was to determine the risk of mortality, ischemic stroke, and bleeding associated with warfarin use in patients with atrial fibril...
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| Veröffentlicht in: | American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2019-10, Vol.19 (5), p.509-515 |
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| creator | Phan, Derek Yang, Su-Jau Shen, Albert Y.-J. Lee, Ming-Sum |
| description | Background
There is limited information on the risks and benefits of anticoagulation in patients with atrial fibrillation receiving peritoneal dialysis.
Objective
The aim was to determine the risk of mortality, ischemic stroke, and bleeding associated with warfarin use in patients with atrial fibrillation receiving peritoneal dialysis.
Patients and methods
This is a retrospective observational study of a multi-ethnic cohort of patients with atrial fibrillation receiving peritoneal dialysis in the United States. Using a dialysis registry, we identified 476 patients with atrial fibrillation receiving peritoneal dialysis. Among these patients, 115 (24%) were treated with warfarin. Cox proportional hazard models were used to compare risks of mortality, ischemic stroke and bleeding between the groups.
Results
Compared to untreated patients, patients receiving warfarin were older (67.3 ± 10.8 vs 62.9 ± 13.3 years) and more likely to be white (42% vs 31%). Prevalence of comorbidities including hypertension, hyperlipidemia, diabetes, heart failure, and prior ischemic stroke were similar between the two groups. All cause mortality rates were 19.9 per 100 person-years in the warfarin group and 21.0 per 100 person-years in the untreated group. There was no difference between groups in the risk of mortality [hazard ratio (HR) 0.8, 95% confidence interval (CI) 0.53–1.2,
p
= 0.28], ischemic stroke (HR 2.3, 95% CI 0.94–5.4,
p
= 0.07), hemorrhagic stroke (HR 2.0, 95% CI 0.32–12.8,
p
= 0.46), gastrointestinal bleeding (HR 0.92, 95% CI 0.39–2.2,
p
= 0.86), or any bleeding (HR 1.2, 95% 0.60–2.3,
p
= 0.65). Even in the subgroup of patients with > 70% time in therapeutic range, no association was seen between warfarin treatment and mortality.
Conclusion
There is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis. |
| doi_str_mv | 10.1007/s40256-019-00347-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2491617134</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2491617134</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-4f4c69631c0a58a221081516068c0484411967eb7741a24d44bd4802869d33c73</originalsourceid><addsrcrecordid>eNp9kMtOAyEUhonRaL28gAtD4tZRDlAYlvVuotF4ie4IZRilTmcqUE2XvrlovexcnZOc7_9P8iG0CWQXCJF7kRPaFwUBVRDCuCzYAuoBSFVAKR8Wv_Z-waiUK2g1xhEhIKlUy2iFAQEhFPTQ-1FdO5twV-N7E2oTfIu7Fp9F--TG3uKbFLpnt4P3G-cq3z7uYNNW-KILyTQ-zXDGr0zyrk0Rv_n0hAcpeNPgYz8MvmnyKbddO-v8a07jKxd86lqXicOMzaKP62ipNk10G99zDd0dH90enBbnlydnB4PzwnJQqeA1t0IJBpaYfmkoBVJCHwQRpSW85BxACemGUnIwlFecDyteEloKVTFmJVtD2_PeSehepi4mPeqmoc0vNeUKBEhgPFN0TtnQxRhcrSfBj02YaSD607qeW9fZuv6yrlkObX1XT4djV_1GfjRngM2BmE_towt_v_-p_QAC6Ywm</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2491617134</pqid></control><display><type>article</type><title>Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Phan, Derek ; Yang, Su-Jau ; Shen, Albert Y.-J. ; Lee, Ming-Sum</creator><creatorcontrib>Phan, Derek ; Yang, Su-Jau ; Shen, Albert Y.-J. ; Lee, Ming-Sum</creatorcontrib><description>Background
There is limited information on the risks and benefits of anticoagulation in patients with atrial fibrillation receiving peritoneal dialysis.
Objective
The aim was to determine the risk of mortality, ischemic stroke, and bleeding associated with warfarin use in patients with atrial fibrillation receiving peritoneal dialysis.
Patients and methods
This is a retrospective observational study of a multi-ethnic cohort of patients with atrial fibrillation receiving peritoneal dialysis in the United States. Using a dialysis registry, we identified 476 patients with atrial fibrillation receiving peritoneal dialysis. Among these patients, 115 (24%) were treated with warfarin. Cox proportional hazard models were used to compare risks of mortality, ischemic stroke and bleeding between the groups.
Results
Compared to untreated patients, patients receiving warfarin were older (67.3 ± 10.8 vs 62.9 ± 13.3 years) and more likely to be white (42% vs 31%). Prevalence of comorbidities including hypertension, hyperlipidemia, diabetes, heart failure, and prior ischemic stroke were similar between the two groups. All cause mortality rates were 19.9 per 100 person-years in the warfarin group and 21.0 per 100 person-years in the untreated group. There was no difference between groups in the risk of mortality [hazard ratio (HR) 0.8, 95% confidence interval (CI) 0.53–1.2,
p
= 0.28], ischemic stroke (HR 2.3, 95% CI 0.94–5.4,
p
= 0.07), hemorrhagic stroke (HR 2.0, 95% CI 0.32–12.8,
p
= 0.46), gastrointestinal bleeding (HR 0.92, 95% CI 0.39–2.2,
p
= 0.86), or any bleeding (HR 1.2, 95% 0.60–2.3,
p
= 0.65). Even in the subgroup of patients with > 70% time in therapeutic range, no association was seen between warfarin treatment and mortality.
Conclusion
There is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis.</description><identifier>ISSN: 1175-3277</identifier><identifier>EISSN: 1179-187X</identifier><identifier>DOI: 10.1007/s40256-019-00347-3</identifier><identifier>PMID: 31016691</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Age ; Aged ; Anticoagulants - therapeutic use ; Atrial Fibrillation - drug therapy ; Brain Ischemia - drug therapy ; Cardiac arrhythmia ; Cardiology ; Confidence intervals ; Diabetes ; Female ; Heart failure ; Hemorrhage - chemically induced ; Humans ; Hypertension ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Nonsteroidal anti-inflammatory drugs ; Original Research Article ; Patients ; Peritoneal dialysis ; Peritoneal Dialysis - methods ; Pharmacology/Toxicology ; Pharmacotherapy ; Pharmacy ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Stroke ; Stroke - chemically induced ; Survival analysis ; Thromboembolism ; United States ; Warfarin - adverse effects ; Warfarin - therapeutic use</subject><ispartof>American journal of cardiovascular drugs : drugs, devices, and other interventions, 2019-10, Vol.19 (5), p.509-515</ispartof><rights>Springer Nature Switzerland AG 2019</rights><rights>Copyright Springer Nature B.V. Oct 2019</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-4f4c69631c0a58a221081516068c0484411967eb7741a24d44bd4802869d33c73</citedby><cites>FETCH-LOGICAL-c419t-4f4c69631c0a58a221081516068c0484411967eb7741a24d44bd4802869d33c73</cites><orcidid>0000-0001-6121-6452</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40256-019-00347-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40256-019-00347-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31016691$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phan, Derek</creatorcontrib><creatorcontrib>Yang, Su-Jau</creatorcontrib><creatorcontrib>Shen, Albert Y.-J.</creatorcontrib><creatorcontrib>Lee, Ming-Sum</creatorcontrib><title>Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis</title><title>American journal of cardiovascular drugs : drugs, devices, and other interventions</title><addtitle>Am J Cardiovasc Drugs</addtitle><addtitle>Am J Cardiovasc Drugs</addtitle><description>Background
There is limited information on the risks and benefits of anticoagulation in patients with atrial fibrillation receiving peritoneal dialysis.
Objective
The aim was to determine the risk of mortality, ischemic stroke, and bleeding associated with warfarin use in patients with atrial fibrillation receiving peritoneal dialysis.
Patients and methods
This is a retrospective observational study of a multi-ethnic cohort of patients with atrial fibrillation receiving peritoneal dialysis in the United States. Using a dialysis registry, we identified 476 patients with atrial fibrillation receiving peritoneal dialysis. Among these patients, 115 (24%) were treated with warfarin. Cox proportional hazard models were used to compare risks of mortality, ischemic stroke and bleeding between the groups.
Results
Compared to untreated patients, patients receiving warfarin were older (67.3 ± 10.8 vs 62.9 ± 13.3 years) and more likely to be white (42% vs 31%). Prevalence of comorbidities including hypertension, hyperlipidemia, diabetes, heart failure, and prior ischemic stroke were similar between the two groups. All cause mortality rates were 19.9 per 100 person-years in the warfarin group and 21.0 per 100 person-years in the untreated group. There was no difference between groups in the risk of mortality [hazard ratio (HR) 0.8, 95% confidence interval (CI) 0.53–1.2,
p
= 0.28], ischemic stroke (HR 2.3, 95% CI 0.94–5.4,
p
= 0.07), hemorrhagic stroke (HR 2.0, 95% CI 0.32–12.8,
p
= 0.46), gastrointestinal bleeding (HR 0.92, 95% CI 0.39–2.2,
p
= 0.86), or any bleeding (HR 1.2, 95% 0.60–2.3,
p
= 0.65). Even in the subgroup of patients with > 70% time in therapeutic range, no association was seen between warfarin treatment and mortality.
Conclusion
There is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis.</description><subject>Age</subject><subject>Aged</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Brain Ischemia - drug therapy</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Female</subject><subject>Heart failure</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Original Research Article</subject><subject>Patients</subject><subject>Peritoneal dialysis</subject><subject>Peritoneal Dialysis - methods</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Pharmacy</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - chemically induced</subject><subject>Survival analysis</subject><subject>Thromboembolism</subject><subject>United States</subject><subject>Warfarin - adverse effects</subject><subject>Warfarin - therapeutic use</subject><issn>1175-3277</issn><issn>1179-187X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kMtOAyEUhonRaL28gAtD4tZRDlAYlvVuotF4ie4IZRilTmcqUE2XvrlovexcnZOc7_9P8iG0CWQXCJF7kRPaFwUBVRDCuCzYAuoBSFVAKR8Wv_Z-waiUK2g1xhEhIKlUy2iFAQEhFPTQ-1FdO5twV-N7E2oTfIu7Fp9F--TG3uKbFLpnt4P3G-cq3z7uYNNW-KILyTQ-zXDGr0zyrk0Rv_n0hAcpeNPgYz8MvmnyKbddO-v8a07jKxd86lqXicOMzaKP62ipNk10G99zDd0dH90enBbnlydnB4PzwnJQqeA1t0IJBpaYfmkoBVJCHwQRpSW85BxACemGUnIwlFecDyteEloKVTFmJVtD2_PeSehepi4mPeqmoc0vNeUKBEhgPFN0TtnQxRhcrSfBj02YaSD607qeW9fZuv6yrlkObX1XT4djV_1GfjRngM2BmE_towt_v_-p_QAC6Ywm</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Phan, Derek</creator><creator>Yang, Su-Jau</creator><creator>Shen, Albert Y.-J.</creator><creator>Lee, Ming-Sum</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0001-6121-6452</orcidid></search><sort><creationdate>20191001</creationdate><title>Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis</title><author>Phan, Derek ; Yang, Su-Jau ; Shen, Albert Y.-J. ; Lee, Ming-Sum</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-4f4c69631c0a58a221081516068c0484411967eb7741a24d44bd4802869d33c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Aged</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Brain Ischemia - drug therapy</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Confidence intervals</topic><topic>Diabetes</topic><topic>Female</topic><topic>Heart failure</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Original Research Article</topic><topic>Patients</topic><topic>Peritoneal dialysis</topic><topic>Peritoneal Dialysis - methods</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Pharmacy</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - chemically induced</topic><topic>Survival analysis</topic><topic>Thromboembolism</topic><topic>United States</topic><topic>Warfarin - adverse effects</topic><topic>Warfarin - therapeutic use</topic><toplevel>online_resources</toplevel><creatorcontrib>Phan, Derek</creatorcontrib><creatorcontrib>Yang, Su-Jau</creatorcontrib><creatorcontrib>Shen, Albert Y.-J.</creatorcontrib><creatorcontrib>Lee, Ming-Sum</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phan, Derek</au><au>Yang, Su-Jau</au><au>Shen, Albert Y.-J.</au><au>Lee, Ming-Sum</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis</atitle><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle><stitle>Am J Cardiovasc Drugs</stitle><addtitle>Am J Cardiovasc Drugs</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>19</volume><issue>5</issue><spage>509</spage><epage>515</epage><pages>509-515</pages><issn>1175-3277</issn><eissn>1179-187X</eissn><abstract>Background
There is limited information on the risks and benefits of anticoagulation in patients with atrial fibrillation receiving peritoneal dialysis.
Objective
The aim was to determine the risk of mortality, ischemic stroke, and bleeding associated with warfarin use in patients with atrial fibrillation receiving peritoneal dialysis.
Patients and methods
This is a retrospective observational study of a multi-ethnic cohort of patients with atrial fibrillation receiving peritoneal dialysis in the United States. Using a dialysis registry, we identified 476 patients with atrial fibrillation receiving peritoneal dialysis. Among these patients, 115 (24%) were treated with warfarin. Cox proportional hazard models were used to compare risks of mortality, ischemic stroke and bleeding between the groups.
Results
Compared to untreated patients, patients receiving warfarin were older (67.3 ± 10.8 vs 62.9 ± 13.3 years) and more likely to be white (42% vs 31%). Prevalence of comorbidities including hypertension, hyperlipidemia, diabetes, heart failure, and prior ischemic stroke were similar between the two groups. All cause mortality rates were 19.9 per 100 person-years in the warfarin group and 21.0 per 100 person-years in the untreated group. There was no difference between groups in the risk of mortality [hazard ratio (HR) 0.8, 95% confidence interval (CI) 0.53–1.2,
p
= 0.28], ischemic stroke (HR 2.3, 95% CI 0.94–5.4,
p
= 0.07), hemorrhagic stroke (HR 2.0, 95% CI 0.32–12.8,
p
= 0.46), gastrointestinal bleeding (HR 0.92, 95% CI 0.39–2.2,
p
= 0.86), or any bleeding (HR 1.2, 95% 0.60–2.3,
p
= 0.65). Even in the subgroup of patients with > 70% time in therapeutic range, no association was seen between warfarin treatment and mortality.
Conclusion
There is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31016691</pmid><doi>10.1007/s40256-019-00347-3</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6121-6452</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of cardiovascular drugs : drugs, devices, and other interventions, 2019-10, Vol.19 (5), p.509-515 |
| issn | 1175-3277 1179-187X |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Age Aged Anticoagulants - therapeutic use Atrial Fibrillation - drug therapy Brain Ischemia - drug therapy Cardiac arrhythmia Cardiology Confidence intervals Diabetes Female Heart failure Hemorrhage - chemically induced Humans Hypertension Male Medicine Medicine & Public Health Middle Aged Mortality Nonsteroidal anti-inflammatory drugs Original Research Article Patients Peritoneal dialysis Peritoneal Dialysis - methods Pharmacology/Toxicology Pharmacotherapy Pharmacy Proportional Hazards Models Retrospective Studies Risk Factors Stroke Stroke - chemically induced Survival analysis Thromboembolism United States Warfarin - adverse effects Warfarin - therapeutic use |
| title | Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis |
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