Warfarin in atrial fibrillation patients with moderate chronic kidney disease

Robert G. Hart, Lesly A. Pearce, Richard W. Asinger, Charles A. Herzog

Research output: Contribution to journalArticlepeer-review

146 Scopus citations

Abstract

Background and objectives The efficacy of adjusted-dose warfarin for prevention of stroke in atrial fibrillation patients with stage 3 chronic kidney disease (CKD) is unknown. Design, setting, participants, & measurements 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%). Results 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; P < 0.001) by adjusted-dose warfarin compared with aspirin/ low-dose warfarin; there was no difference in major hemorrhage (5 patients versus 6 patients, respectively). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)2599-2604
Number of pages6
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number11
DOIs
StatePublished - Nov 1 2011

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