Warfarin in Atrial Fibrillation Patients with Moderate Chronic Kidney Disease
| Autor: | Charles A. Herzog, Robert G. Hart, Lesly A. Pearce, Richard W. Asinger |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Time Factors Epidemiology Kaplan-Meier Estimate Critical Care and Intensive Care Medicine Severity of Illness Index law.invention Randomized controlled trial Risk Factors law Atrial Fibrillation Stroke Aspirin Hazard ratio Atrial fibrillation Treatment Outcome Nephrology Cardiology Platelet aggregation inhibitor Drug Therapy Combination Female Kidney Diseases medicine.drug Canada medicine.medical_specialty Hemorrhage Risk Assessment Internal medicine medicine Humans International Normalized Ratio cardiovascular diseases Blood Coagulation Aged Proportional Hazards Models Transplantation Chi-Square Distribution business.industry Warfarin Anticoagulants Original Articles medicine.disease United States Chronic Disease business Platelet Aggregation Inhibitors Kidney disease |
| Zdroj: | Clinical Journal of the American Society of Nephrology. 6:2599-2604 |
| ISSN: | 1555-9041 |
| Popis: | The efficacy of adjusted-dose warfarin for prevention of stroke in atrial fibrillation patients with stage 3 chronic kidney disease (CKD) is unknown.Patients with stage 3 CKD participating in the Stroke Prevention in Atrial Fibrillation 3 trials were assessed to determine the effect of warfarin anticoagulation on stroke and major hemorrhage, and whether CKD status independently contributed to stroke risk. High-risk participants (n = 1044) in the randomized trial were assigned to adjusted-dose warfarin (target international normalized ratio 2 to 3) versus aspirin (325 mg) plus fixed, low-dose warfarin (subsequently shown to be equivalent to aspirin alone). Low-risk participants (n = 892) all received 325 mg aspirin daily. The primary outcome was ischemic stroke (96%) or systemic embolism (4%).Among the 1936 participants in the two trials, 42% (n = 805) had stage 3 CKD at entry. Considering the 1314 patients not assigned to adjusted-dose warfarin, the primary event rate was double among those with stage 3 CKD (hazard ratio 2.0, 95% CI 1.2, 3.3) versus those with a higher estimated GFR (eGFR). Among the 516 participants with stage 3 CKD included in the randomized trial, ischemic stroke/systemic embolism was reduced 76% (95% CI 42, 90; P0.001) by adjusted-dose warfarin compared with aspirin/low-dose warfarin; there was no difference in major hemorrhage (5 patients versus 6 patients, respectively).Among atrial fibrillation patients participating in the Stroke Prevention in Atrial Fibrillation III trials, stage 3 CKD was associated with higher rates of ischemic stroke/systemic embolism. Adjusted-dose warfarin markedly reduced ischemic stroke/systemic embolism in high-risk atrial fibrillation patients with stage 3 CKD. |
| Databáze: | OpenAIRE |
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