A DCRI-led study found that using oral anticoagulants, predominantly warfarin, led to increased risk of bleeding and intracranial hemorrhage for patients with atrial fibrillation and end-stage renal disease.
Oral anticoagulation (OAC), a treatment strategy commonly used to prevent stroke in patients with atrial fibrillation, may be harmful for patients with atrial fibrillation and end-stage renal disease, according to a recent study led by the DCRI.
The study, which was led by the DCRI’s Sean Pokorney, MD, MBA, and published in Journal of the American College of Cardiology, used Medicare claims data to analyze a cohort of over 8,000 patients with both atrial fibrillation and end-stage renal disease. The investigators examined patterns of OAC use—and found that about 36 percent of patients in the cohort used OACs sometime during the study period—as well as how this use was associated with outcomes. More than 99 percent of the patients treated with OAC received warfarin. The patients who did use an OAC were more likely to be younger and less likely to have had a prior hospitalization for bleeding.
The study results showed no reduction in risk of stroke or death for patients who took OACs, but an increased risk for bleeding and intracranial hemorrhage, suggesting that OACs may be harmful for patients with atrial fibrillation and end-stage renal disease. This analysis contradicts the 2014 ACC/AHA/HRS guidelines, which recommend use of warfarin (an OAC) for patients with end-stage renal disease.
“Our analysis found that roughly one of every three patients with end-stage renal disease also have atrial fibrillation,” Pokorney (pictured left) said. “Because of the prevalence of the coexistence of these two conditions, it was important for us to better understand the best way to treat these patients. The major finding here is that we need alternative stroke prevention strategies to better treat patients with end-stage renal disease.”
The DCRI’s Jonathan Piccini, MD, MHS (pictured right), the senior author of the study, spoke to Cardiology Today about the potential alternatives. “One potential treatment option that may not lead to increased risks of bleeding is a nonpharmacologic intervention like percutaneous left atrial appendage occlusion/closure (LAAO),” he said. “Left atrial appendage occlusion should be tested in a clinical trial to see if LAAO reduces stroke effectively in patients with atrial fibrillation and end-stage renal disease.”
Other DCRI contributors to this study include DCRI fellow Eric Black-Maier, MD, Christopher Granger, MD; Sreekanth Vemulapalli, MD; Laine Thomas, PhD; and Eric Peterson, MD, MPH. The DCRI’s Anne Hellkamp, MS, provided staff statistical support.