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Article: Ischaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis

TitleIschaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis
Authors
KeywordsAtrial fibrillation
Chronic kidney disease
Ischaemic stroke
Peritoneal dialysis
Issue Date2016
Citation
Europace, 2016, v. 18 n. 5, p. 665-671 How to Cite?
AbstractAIMS: Little is known about the ischaemic stroke risk and benefit of warfarin therapy for stroke prevention in chronic kidney disease (CKD) patients on peritoneal dialysis (PD) with concomitant atrial fibrillation (AF). Our objective was to determine the risk of ischaemic stroke in a 'real-world' cohort of PD patients with AF, and clinical benefit or harm of aspirin and warfarin. METHODS AND RESULTS: This is a single-centred observational study of Chinese patients with non-valvular AF. Hospitalizations with ischaemic stroke and intracranial haemorrhage (ICH) were recorded. Of 9810 patients from a hospital-based AF registry, 271 CKD patients on PD with AF (76.8 +/- 12.5 years, CHA2DS2-VASc: 3.69 +/- 1.83, and HAS-BLED: 2.07 +/- 0.97) were identified. Amongst these PD patients, 24.7% received warfarin; 31.7% received aspirin; and 43.5% received no antithrombotic therapy. Amongst patients with no antithrombotic therapy, annual incidence of ischaemic stroke in PD patients was comparable with those non-CKD counterparts (9.32 vs. 9.30%/year). Similar to non-CKD patients, annual incidence of ischaemic stroke increased with increasing CHA2DS2-VASc score (CHA2DS2-VASc = 0-1: 5.76 vs. 5.70%/year, P = 1.00; and CHA2DS2-VASc >/= 2: 10.80 vs. 9.94%/year, P = 0.78). Amongst PD patients, warfarin therapy was associated with lower risk of ischaemic stroke compared with aspirin [Hazard ratio (HR): 0.16, 95% confidence interval (CI): 0.04-0.66, P = 0.01] and no therapy (HR: 0.19, 95% CI: 0.06-0.65, P = 0.01), but not associated with a higher risk of ICH. CONCLUSION: In CKD patients on PD with AF, who had similar ischaemic stroke risk as non-CKD counterparts, warfarin therapy is associated with reduction in risk of ischaemic stroke without a higher risk of ICH.
Persistent Identifierhttp://hdl.handle.net/10722/227377
ISSN
2023 Impact Factor: 7.9
2023 SCImago Journal Rankings: 2.895
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, PHM-
dc.contributor.authorHuang, D-
dc.contributor.authorYip, PS-
dc.contributor.authorHai, SHJJ-
dc.contributor.authorTse, HF-
dc.contributor.authorChan, DTM-
dc.contributor.authorLip, GY-
dc.contributor.authorLo, WK-
dc.contributor.authorSiu, DCW-
dc.date.accessioned2016-07-18T09:10:07Z-
dc.date.available2016-07-18T09:10:07Z-
dc.date.issued2016-
dc.identifier.citationEuropace, 2016, v. 18 n. 5, p. 665-671-
dc.identifier.issn1099-5129-
dc.identifier.urihttp://hdl.handle.net/10722/227377-
dc.description.abstractAIMS: Little is known about the ischaemic stroke risk and benefit of warfarin therapy for stroke prevention in chronic kidney disease (CKD) patients on peritoneal dialysis (PD) with concomitant atrial fibrillation (AF). Our objective was to determine the risk of ischaemic stroke in a 'real-world' cohort of PD patients with AF, and clinical benefit or harm of aspirin and warfarin. METHODS AND RESULTS: This is a single-centred observational study of Chinese patients with non-valvular AF. Hospitalizations with ischaemic stroke and intracranial haemorrhage (ICH) were recorded. Of 9810 patients from a hospital-based AF registry, 271 CKD patients on PD with AF (76.8 +/- 12.5 years, CHA2DS2-VASc: 3.69 +/- 1.83, and HAS-BLED: 2.07 +/- 0.97) were identified. Amongst these PD patients, 24.7% received warfarin; 31.7% received aspirin; and 43.5% received no antithrombotic therapy. Amongst patients with no antithrombotic therapy, annual incidence of ischaemic stroke in PD patients was comparable with those non-CKD counterparts (9.32 vs. 9.30%/year). Similar to non-CKD patients, annual incidence of ischaemic stroke increased with increasing CHA2DS2-VASc score (CHA2DS2-VASc = 0-1: 5.76 vs. 5.70%/year, P = 1.00; and CHA2DS2-VASc >/= 2: 10.80 vs. 9.94%/year, P = 0.78). Amongst PD patients, warfarin therapy was associated with lower risk of ischaemic stroke compared with aspirin [Hazard ratio (HR): 0.16, 95% confidence interval (CI): 0.04-0.66, P = 0.01] and no therapy (HR: 0.19, 95% CI: 0.06-0.65, P = 0.01), but not associated with a higher risk of ICH. CONCLUSION: In CKD patients on PD with AF, who had similar ischaemic stroke risk as non-CKD counterparts, warfarin therapy is associated with reduction in risk of ischaemic stroke without a higher risk of ICH.-
dc.languageeng-
dc.relation.ispartofEuropace-
dc.subjectAtrial fibrillation-
dc.subjectChronic kidney disease-
dc.subjectIschaemic stroke-
dc.subjectPeritoneal dialysis-
dc.titleIschaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis-
dc.typeArticle-
dc.identifier.emailChan, PHM: phmchan@hku.hk-
dc.identifier.emailHai, SHJJ: haishjj@hku.hk-
dc.identifier.emailTse, HF: hftse@hkucc.hku.hk-
dc.identifier.emailChan, DTM: dtmchan@hkucc.hku.hk-
dc.identifier.emailSiu, DCW: cwdsiu@hkucc.hku.hk-
dc.identifier.authorityChan, PHM=rp01864-
dc.identifier.authorityHai, SHJJ=rp02047-
dc.identifier.authorityTse, HF=rp00428-
dc.identifier.authorityChan, DTM=rp00394-
dc.identifier.authoritySiu, DCW=rp00534-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1093/europace/euv289-
dc.identifier.scopuseid_2-s2.0-84975223708-
dc.identifier.hkuros259695-
dc.identifier.volume18-
dc.identifier.issue5-
dc.identifier.spage665-
dc.identifier.epage671-
dc.identifier.isiWOS:000377470200008-
dc.identifier.issnl1099-5129-

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