BACKGROUND: The benefit and risk of oral anticoagulation in dialysis patients are debated controversially. METHODS: We prospectively followed 235 dialysis patients of the INVOR Study (Study of Incident Dialysis Patients in Vorarlberg) for up to 7 years and analysed the prevalence and incidence of atrial fibrillation (AF) and the impact of coumarin therapy on survival. Oral anticoagulation was monitored frequently. RESULTS: A total of 748 person-years were recorded with a median follow-up of 2.84 years. Twelve patients (5.1%) had AF at the start of dialysis. During follow-up, 40 patients (17.0%) developed AF, representing an incidence of 5.85 per 100 person-years. AF was positively associated with mortality (P = 0.004). Forty-six (19.6%) of the 235 patients were treated with coumarins. The majority (93.7%) had a clear indication for oral anticoagulation. In 65% of our patients, AF was the indication for coumarins. Patients without coumarins and without AF represented our reference group. The mortality risk of the coumarin-treated patients with AF or an alternative indication for coumarins was slightly lower compared to the reference group [hazard ratio (HR) 95% confidence interval (CI): 0.80 (0.28-2.29), P = 0.679 and 0.42 (0.16-1.10), P = 0.078, respectively]. No patient under sufficient oral anticoagulation experienced a stroke or a fatal bleeding event. Patients with AF and a contraindication for coumarins had a significantly higher mortality risk compared to the reference group [HR (95% CI): 3.90 (2.16-7.04), P < 0.001]. CONCLUSIONS: Our data suggest that coumarins might be less harmful than previously anticipated when clearly indicated and closely monitored.
BACKGROUND: The benefit and risk of oral anticoagulation in dialysis patients are debated controversially. METHODS: We prospectively followed 235 dialysis patients of the INVOR Study (Study of Incident Dialysis Patients in Vorarlberg) for up to 7 years and analysed the prevalence and incidence of atrial fibrillation (AF) and the impact of coumarin therapy on survival. Oral anticoagulation was monitored frequently. RESULTS: A total of 748 person-years were recorded with a median follow-up of 2.84 years. Twelve patients (5.1%) had AF at the start of dialysis. During follow-up, 40 patients (17.0%) developed AF, representing an incidence of 5.85 per 100 person-years. AF was positively associated with mortality (P = 0.004). Forty-six (19.6%) of the 235 patients were treated with coumarins. The majority (93.7%) had a clear indication for oral anticoagulation. In 65% of our patients, AF was the indication for coumarins. Patients without coumarins and without AF represented our reference group. The mortality risk of the coumarin-treated patients with AF or an alternative indication for coumarins was slightly lower compared to the reference group [hazard ratio (HR) 95% confidence interval (CI): 0.80 (0.28-2.29), P = 0.679 and 0.42 (0.16-1.10), P = 0.078, respectively]. No patient under sufficient oral anticoagulation experienced a stroke or a fatal bleeding event. Patients with AF and a contraindication for coumarins had a significantly higher mortality risk compared to the reference group [HR (95% CI): 3.90 (2.16-7.04), P < 0.001]. CONCLUSIONS: Our data suggest that coumarins might be less harmful than previously anticipated when clearly indicated and closely monitored.
Authors: James B Wetmore; Edward F Ellerbeck; Jonathan D Mahnken; Milind Phadnis; Sally K Rigler; Purna Mukhopadhyay; John A Spertus; Xinhua Zhou; Qingjiang Hou; Theresa I Shireman Journal: Ann Epidemiol Date: 2013-01-16 Impact factor: 3.797
Authors: Oliver Königsbrügge; Florian Posch; Marlies Antlanger; Josef Kovarik; Renate Klauser-Braun; Josef Kletzmayr; Sabine Schmaldienst; Martin Auinger; Günther Zuntner; Matthias Lorenz; Ella Grilz; Gerald Stampfel; Stefan Steiner; Ingrid Pabinger; Marcus Säemann; Cihan Ay Journal: PLoS One Date: 2017-01-04 Impact factor: 3.240
Authors: Karolina Szummer; Alessandro Gasparini; Staffan Eliasson; Johan Ärnlöv; Abdul Rashid Qureshi; Peter Bárány; Marie Evans; Leif Friberg; Juan Jesus Carrero Journal: J Am Heart Assoc Date: 2017-03-01 Impact factor: 5.501