STOCKHOLM, SWEDEN—A study in JAMA Anti-coagulation has reported that warfarin could be beneficial for patients with atrial fibrillation (AF) even if they have chronic kidney disease.
Patients with AF and chronic renal disease who were discharged on warfarin therapy after a myocardial infarction (MI) had lower risks of death, further MI and ischemic stroke at one year compared to those who were not taking warfarin. And the treatment did not increase bleeding. First author Juan Jesus Carrero PhD from the Karolinska Institutet in Stockholm told AudioMedica.com with MD-FM this was across the spectrum of kidney failure:
“We went from mild, moderate to severe end-stage renal disease and we observed that warfarin treatment — in each stage of chronic kidney disease — was associated with a lower rate of events,” he observed.
He explained that in the preceding two to three years practitioners had backed off from warfarin treatment in these patients after a few studies suggested it might increase the risk of bleeding, stroke and death among patients on dialysis. But that this was not now warranted.
In an editorial comment in JAMA Dr. Mintu Turakhia MD pointed out that the benefits of warfarin might not have been spotted in another setting: “Sweden does better with managing warfarin than any other country, anywhere. In the United States, we are significantly worse at managing warfarin and it’s not clear that the same benefits would be shown, ” he said in an interview.
He also said this new research had been a step forwards and that clinicians should not regard chronic kidney disease as a disqualifier for anticoagulation: “These patients are at high risk for stroke: we know that. And although the data is observational it’s a well done study and they’ve shown that you can accomplish meaningful reductions in stroke and avoid excess bleeding if you manage the warfarin carefully.”
SOURCE : Carrero J.J et al. Warfarin, Kidney Dysfunction, and Outcomes Following Acute Myocardial Infarction in Patients With Atrial Fibrillation, JAMA. 2014;311(9):919-928. doi:10.1001/jama.2014.1334.
SOURCE 2: Winkelmayer W.C. et al., Warfarin Treatment in Patients With Atrial Fibrillation and Advanced Chronic Kidney Disease: Sins of Omission or Commission?, JAMA. 2014;311(9):913-915. doi:10.1001/jama.2014.1781.
CONTRIBUTOR: Dr. Juan Jesus Carrero PhD
Assistant Professor Renal Medicine, Karolinska Institutet, Stockholm, Sweden.
CONTRIBUTOR 2: Dr. Mintu Turakhia MD
Assistant Professor of Medicine, Stanford University, California.