Among hemodialysis (HD) patients with atrial fibrillation, black, Hispanic, and Asian patients experience higher rates of stroke than white patients, and, for reasons that are unclear, appear less likely to fill prescriptions for anticoagulants, according to a new study.

In an analysis of 56,587 patients, black, Hispanic, and Asian patients were 13%, 15%, and 16% more likely to experience stroke, respectively, than white patients, and 10%, 17%, and 28% less likely to fill a warfarin prescription, respectively, Paul L. Kimmel, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases, and colleagues reported in the Journal of the American Society of Nephrology.

Warfarin prescription was associated with reduced risk of all-cause stroke, mortality, and ischemic strokes, but was also associated with increased risk of hemorrhagic strokes. Excess strokes among minorities could be reduced by 7%, 10%, and 12% among black, Hispanic, and Asian patients, respectively, if an intervention equalized the distribution of filled warfarin prescriptions among minorities to that of white patients, according to the investigators.


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“Physicians and other practitioners can modify their prescription patterns to address the racial/ethnic disparities in stroke incidence in patients with [end-stage renal disease] on HD, suggesting that they may be the individuals who could implement interventions most readily,” the authors wrote.

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References

Waddy SP, Solomon AJ, Becerra AZ, et al. Racial/ethnic disparities in atrial fibrillation treatment and outcomes among dialysis patients in the United States [published online February 20, 2020]. J Am Soc Nephrol.  doi: 10.1681/ASN.2019050543

Racial/ethnic disparities in stroke-prevention among patients undergoing dialysis. American Society of Nephrology; February 20, 2020.