Association of warfarin with congestive heart failure and peripheral artery occlusive disease in hemodialysis patients with atrial fibrillation

Kuo-Hua Lee; Szu-Yuan Li; Jin-Sin Liu; Chi-Ting Huang; Ying-Ying Chen; Yao-Ping Lin; Chih-Cheng Hsu; Der-Cherng Tarng

doi:10.1016/j.jcma.2016.10.012

Association of warfarin with congestive heart failure and peripheral artery occlusive disease in hemodialysis patients with atrial fibrillation

J Chin Med Assoc. 2017 May;80(5):277-282. doi: 10.1016/j.jcma.2016.10.012. Epub 2017 Feb 14.

Authors

Kuo-Hua Lee¹, Szu-Yuan Li², Jin-Sin Liu³, Chi-Ting Huang³, Ying-Ying Chen⁴, Yao-Ping Lin⁵, Chih-Cheng Hsu⁶, Der-Cherng Tarng⁷

Affiliations

¹ 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.
² Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
³ Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Taipei, Taiwan, ROC.
⁴ Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁵ National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁶ Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
⁷ 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.

PMID: 28214287
DOI: 10.1016/j.jcma.2016.10.012

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.

Conclusion: Warfarin may be associated with vascular calcification, increasing the risks of congestive heart failure and peripheral artery occlusive disease among HD-AF patients.

Keywords: atrial fibrillation; hemodialysis; warfarin.

MeSH terms

Adult
Aged
Anticoagulants / adverse effects*
Arterial Occlusive Diseases / etiology*
Atrial Fibrillation / complications*
Brain Ischemia / etiology
Female
Heart Failure / etiology*
Humans
Male
Middle Aged
Renal Dialysis / adverse effects*
Stroke / etiology
Vascular Calcification / etiology
Warfarin / adverse effects*

Substances

Anticoagulants
Warfarin