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논문분류	춘계학술대회 초록집
제목	Association between Warfarin Use and Clinical Outcomes in Hemodialysis Patients with Atrial Fibrillation
저자	Kyu Hyang Cho
출판정보	2024; 2024(1):
키워드
초록	Objectives: The use of warfarin, commonly employed in atrial fibrillation, has not yet yielded a clear consensus regarding its impact on complication rates in hemodialysis (HD) patients. This study aims to compare clinical outcomes based on the use of warfarin by utilizing a population-based database. Methods: A retrospective analysis was conducted utilizing data from adult patient (age ≥ 18 years) undergoing maintenance HD (≥ 3 months, ≥ 2 times per week) who participated in HD quality assessment programs performed by HIRA. Among 54,903, we included 4863 patients who had at least ICD-10 code (I48) for atrial fibrillation during 18 months, which comprised the 6 months during the HD quality assessment and the preceding 12 months. We divided into two group based on the use of warfarin; the No group with no prescription of warfarin (n = 4,009); the Warfarin group with warfarin prescription of ≥ 30 days during 6 months of the HD quality assessment program (n = 820). Results: Cox regression analyses revealed that hazard ratio for all-cause mortality of the Warfarin group showed 1.15 (95% CI, 1.05–1.28; P = 0.005) in univariate analysis and 1.11 (95% CI, 1.01–1.23, P = 0.047) in multivariable analysis compared to the No group. The 5-year hemorrhagic stroke-free survival rate in the No and Warfarin groups were 93.3% and 90.8%, respectively (P = 0.002). Cox regression analyses revealed that hemorrhagic stroke was significantly associated with the use of warfarin, but the statistically significant association between the use of warfarin and ischemic stroke or cardiovascular events were not observed. Conclusions: This study does not demonstrate superior outcomes in terms of survival, ischemic stroke, hemorrhagic stroke, and cardiovascular events with the use of warfarin compared to the non-user group. These findings suggest a need for caution in the use of warfarin in HD patients with concurrent atrial fibrillation.
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