S-500 The Risk of Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis = S-500 The Risk of Warfarin Use in Patients with Atrial Fibrillation Undergoing Hemodialysis

다국어 초록 (Multilingual Abstract)

Background: The aim of this study is to elucidate the benefits and risks of the use of warfarin in patients with AF undergoing dialysis using a population-based, large-scale Korean registry data to compare clinical outcomes between warfarin users and non-users. Methods: Data were extracted from the Health Insurance Review and Assessment Service (HIRA), which is a nationwide mandatory social insurance database of the total Korean citizens who has enrolled in National Health Information Service between 2009 and 2013. The end-stage renal disease-atrial fibrillation (ESRD-AF) cohort was extracted from the entire Korean population identified ESRD patients and AF patients. Major adverse cardiac and cerebrovascular events (MACCEs) were defined as the composites of acute myocardial infarction, ischemic stroke, or peripheral arterial disease, while all bleeding events were defined as the composites of hemorrhagic stroke and gastrointestinal bleeding. Results: The mean age was 66.6±12.2 years, and 5806 (58.2%) were men. Among 9974 dialysis patients with AF, 2921 (29.3%) were warfarin users. After propensity score matching to adjust for all described baseline differences, total 5548 subjects were remained after matching, and the differences of baseline variables were distributed equally in both warfarin user and non-user groups. During a mean follow-up duration of 15.9±11.1 months, MACCEs and all bleeding events were occurred in 1756 (17.6%) and 883 (8.9%) patients, respectively. In a multiple Cox model with age, sex, history of diabetes, hypertension, malignancy and liver cirrhosis, the use of medications, CHA2DS2-VASc and HAS-BLED scores being used as covariates, warfarin use was significantly associated with an increased risk of hemorrhagic stroke [hazard (HR), 1.441; 95% confidence interval (CI), 1.09-1.91; p＝0.010]. Furthermore, the significant relationship between warfarin use and hemorrhagic stroke was still remained in matched subjects (HR, 1.563; 95% CI, 1.10-2.22; p＝0.013). Conclusions: This finding suggests that the use of warfarin in dialysis patients would be more cautious even clearly indicated in general population.