Warfarin Linked to Mortality, Bleeding, Among Patients With End-Stage Renal Disease

Warfarin use is associated with an increased risk of mortality, bleeding, and myocardial infarction (MI) among patients with end-stage renal disease (ESRD) on dialysis, according to a recent study.

Whether warfarin therapy is beneficial for patients with chronic kidney disease (CKD) or ESRD remains controversial.
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For their study, the researchers assessed 59 adult patients with stage 3-6 CKD who had initiated warfarin treatment between 2011 and 2013, and 144 patients with stage 3-6 CKD who had indications for anticoagulation therapy but had not initiated warfarin treatment. Follow-up lasted 5.8 years.

Cox proportional hazard regression analysis was conducted to estimate the all-cause mortality risk associated with warfarin treatment. Poisson regression analysis was used to determine the risk of significant bleeding and major adverse cardiovascular events. Factors including age, gender, diabetes mellitus, use of antiplatelet agents, and preexisting cardiovascular disease were assessed via adjustment models. Additionally, patients were stratified by pre-dialysis CKD stages 3-5 vs ESRD.

Results indicated that the rate of unadjusted mortality was higher in patients with CKD on warfarin therapy. However, following multivariate adjustment and stratification by CKD stage, this risk remained significant in ESRD patients on warfarin. Adjusted rates of significant bleeding and MI were also found to be higher among patients on warfarin. No differences in the rates of ischemic or hemorrhagic strokes were observed between groups.

“Warfarin use was associated with several-fold higher risk of death, bleeding, and myocardial infarction in dialysis patients,” the researchers concluded. “If additional studies suggest similar associations, the use of warfarin in dialysis patients warrants immediate reconsideration.”

—Christina Vogt

Reference:

Lin MC, Streja E, Soohoo M, et al. Warfarin use and increased mortality in end-stage renal disease. Am J Nephrol. 2017;46(4):249-256. https://doi.org/10.1159/000481207.