Simonetta Genovesi1,2, Paola Rebora3, Maurizio Gallieni4, Andrea Stella5,6, Fabio Badiali7, Ferruccio Conte8, Sonia Pasquali9, Silvio Bertoli10, Patrizia Ondei11, Giuseppe Bonforte12, Claudio Pozzi13, Emanuela Rossi3, Maria Grazia Valsecchi3, Antonio Santoro14. 1. Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza (MB), Italy. simonetta.genovesi@unimib.it. 2. Nephrology Unit, San Gerardo Hospital, Monza, Italy. simonetta.genovesi@unimib.it. 3. Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 4. Nephrology Unit, San Carlo Borromeo Hospital, Milan, Italy. 5. Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza (MB), Italy. 6. Nephrology Unit, San Gerardo Hospital, Monza, Italy. 7. Nephrology Unit, Infermi Hospital, Rimini, Italy. 8. Nephrology Unit, S. Uboldo Hospital, Cernusco sul Naviglio, Italy. 9. Nephrology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy. 10. Nephrology Unit, IRCCS Multimedica, Sesto S. Giovanni, Italy. 11. Nephrology Unit, Ospedali Riuniti, Bergamo, Italy. 12. Nephrology Unit, S. Anna Hospital, Como, Italy. 13. Nephrology Unit, Bassini Hospital, Cinisello, Milan, Italy. 14. Nephrology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
Abstract
BACKGROUND: The aim of this study was to evaluate, in a cohort of haemodialysis patients with atrial fibrillation (AF), the relationship between oral anticoagulant therapy (OAT) and mortality, thromboembolic events and haemorrhage. METHODS: Two hundred and ninety patients with AF were prospectively followed for 4 years. Warfarin and antiplatelet intake, age, dialytic age, comorbidities, CHA2DS2-VASc and HAS-BLED scores were considered as predictors of risk of death, thromboembolism and bleeding events. In patients taking OAT, the international normalized ratio (INR) was assessed and the percentage time in the target therapeutic range (TTR) was calculated. RESULTS: At recruitment, 134/290 patients were taking warfarin. During follow-up there were 170 deaths, 28 thromboembolic events and 95 bleedings. After balancing for treatment propensity, intention-to-treat analysis on OAT intake at recruitment did not show differences in total mortality, thromboembolic events and bleedings, while the as-treated analysis, accounting for treatment switch, showed that patients taking OAT at recruitment had a significantly lower mortality than those not taking it [hazard ratio, HR 0.53 (95% confidence interval 0.28-0.90), p = 0.04], with a decrease of thromboembolic events [HR 0.36 (0.13-1.05), p = 0.06], and an increase of bleedings [HR 1.79 (0.72-4.39), p = 0.20], both non-significant. Among patients taking OAT at recruitment, those continuing to take warfarin had a significant reduction in the risk of total [HR 0.28 (0.14-0.53), p < 0.001] and cardiovascular [HR 0.21 (0.11-0.40), p < 0.001] mortality compared to patients stopping OAT. CONCLUSIONS: In haemodialysis patients with AF, continuously taking warfarin is associated with a reduction of the risk of total and cardiovascular mortality.
BACKGROUND: The aim of this study was to evaluate, in a cohort of haemodialysis patients with atrial fibrillation (AF), the relationship between oral anticoagulant therapy (OAT) and mortality, thromboembolic events and haemorrhage. METHODS: Two hundred and ninety patients with AF were prospectively followed for 4 years. Warfarin and antiplatelet intake, age, dialytic age, comorbidities, CHA2DS2-VASc and HAS-BLED scores were considered as predictors of risk of death, thromboembolism and bleeding events. In patients taking OAT, the international normalized ratio (INR) was assessed and the percentage time in the target therapeutic range (TTR) was calculated. RESULTS: At recruitment, 134/290 patients were taking warfarin. During follow-up there were 170 deaths, 28 thromboembolic events and 95 bleedings. After balancing for treatment propensity, intention-to-treat analysis on OAT intake at recruitment did not show differences in total mortality, thromboembolic events and bleedings, while the as-treated analysis, accounting for treatment switch, showed that patients taking OAT at recruitment had a significantly lower mortality than those not taking it [hazard ratio, HR 0.53 (95% confidence interval 0.28-0.90), p = 0.04], with a decrease of thromboembolic events [HR 0.36 (0.13-1.05), p = 0.06], and an increase of bleedings [HR 1.79 (0.72-4.39), p = 0.20], both non-significant. Among patients taking OAT at recruitment, those continuing to take warfarin had a significant reduction in the risk of total [HR 0.28 (0.14-0.53), p < 0.001] and cardiovascular [HR 0.21 (0.11-0.40), p < 0.001] mortality compared to patients stopping OAT. CONCLUSIONS: In haemodialysis patients with AF, continuously taking warfarin is associated with a reduction of the risk of total and cardiovascular mortality.
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