2024-03-29T07:44:44Z
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oai:niigata-u.repo.nii.ac.jp:00001619
2022-12-15T04:09:12Z
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471:472:473
Association between warfarin use and incidence of ischemic stroke in Japanese hemodialysis patients with chronic sustained atrial fibrillation : a prospective cohort study
Wakasugi, Minako
48
Kazama, Junichiro James
4627
Tokumoto, Akihide
4628
Suzuki, Kensuke
4629
Kageyama, Shinji
4630
Ohya, Kaoru
4631
Miura, Yoshiaki
4632
Kawachi, Mamoru
4633
Takata, Takuma
4634
Nagai, Masaaki
4635
Ohya, Minoru
4636
Kutsuwada, Keiko
4637
Okajima, Hideo
4638
Ei, Isei
4639
Takahashi, Sachio
4640
Narita, Ichiei
4641
Brain Infarction
Cohort Studies
Hemorrhage
Mortality
Propensity Score
Background: Although generally recommended for atrial fibrillation (AF) in the general population, the efficacy and safety of warfarin in hemodialysis patients remains controversial. Warfarin use in hemodialysis patients may confer an additional risk of bleeding that is not appreciated in patients without renal failure because hemodialysis patients have platelet defects and receive anticoagulation agents during dialysis. The incidence of major bleeding was reported to be higher in Japanese AF patients on warfarin therapy compared to patients in other countries, suggesting that racial differences may influence bleeding tendency. Thus, examining risks and benefits of warfarin therapy in Japanese hemodialysis patients with AF is important. Methods: To determine associations between warfarin use and new ischemic stroke events, major bleeding, and all-cause mortality, a prospective cohort study of 60 Japanese hemodialysis patients with chronic sustained AF was conducted using Cox proportional modeling and propensity score matching. Results: The mean patient age was 68.1 years. During 110 person-years of follow-up, 13 ischemic strokes occurred. After adjusting for CHADS2 score, warfarin use was not associated with a significant reduction in ischemic stroke events (HR 3.36; 95% CI, 0.94 to 11.23). Similar results were obtained after propensity score matching (HR 3.36; 95% CI, 0.67 to 16.66). Warfarin use was not associated with significant increases in major bleeding or all-cause mortality. Conclusions: These results suggest that warfarin may not prevent ischemic stroke in Japanese hemodialysis patients with chronic sustained AF. Adequately powered studies are needed to determine the risks and benefits of anticoagulation therapy in these patients.
journal article
Springer
2014-08
application/pdf
application/pdf
application/pdf
Clinical and experimental nephrology
4
18
662
669
Clinical and experimental nephrology
AA11126935
13421751
https://niigata-u.repo.nii.ac.jp/record/1619/files/CEN_18(4)_662-669_tables.pdf
https://niigata-u.repo.nii.ac.jp/record/1619/files/CEN_18(4)_662-669_figures.pdf
https://niigata-u.repo.nii.ac.jp/record/1619/files/CEN_18(4)_662-669_manuscript.pdf
eng
info:doi/10.1007/s10157-013-0885-6
The original publication is available at www.springerlink.com