Patients who suffer from both atrial fibrillation and chronic kidney disease (CKD) are at increased risk for stroke or systemic thromboembolism and bleeding, a new study suggests.
Warfarin treatment in this patient population is associated with a decreased risk of stroke and thromboembolism, but it also increases bleeding risk.
For the study, Jonas Bjerring Olesen, MD, of Copenhagen University Hospital Gentofte in Hellerup, Denmark, and colleagues reviewed the records of 132,372 patients in Denmark who had been discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation between 1997 and 2008. Of these, 3,587 (2.7%) had non-end-stage CKD and 901 (0.7%) required renal replacement therapy (RRT).
Compared with patients without renal disease, those with non-end-stage CKD had a significant 49% increased risk of stroke or systemic thromboembolism. Patients who required RRT had an 83% increased risk, according to a report in the New England Journal of Medicine (2012;367:625-635). Patients with non-end-stage CKD and those requiring RRT had a 2.2 and 2.7 times increased risk of bleeding.
Warfarin significantly reduced the risk of stroke or systemic thromboembolism by 41% for the study population as a whole and 56% among patients requiring RRT. Warfarin use was not associated with a significantly reduced risk in patients with non-end-stage CKD. Aspirin use did not decrease the risk.