Incidence and prediction of ischemic stroke among atrial fibrillation patients with end-stage renal disease requiring dialysis

Chao, Tze‐Fan; Liu, Chia-Jen; Wang, Kang-Ling; Lin, Yenn‐Jiang; Chang, Shih‐Lin; Lo, Li‐Wei; Hu, Yu‐Feng; Tuan, Ta‐Chuan; Chung, Fa Po; Liao, Jo‐Nan; Chen, Tzeng Ji; Lip, Gregory Y.H.; Chen, Shih‐Ann

doi:10.1016/j.hrthm.2014.06.021

Cited by 74 publications

(57 citation statements)

References 32 publications

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“…However, the results of these studies must be interpreted cautiously because of selection bias (single centers), small samples, uncontrolled baseline risk of stroke, and lack of adjustment for the competing risks of stroke and death. Although correspondence between a higher CHA 2 DS 2 -VASc score and a higher risk of stroke in patients with ESRD was observed in the present cohort and by Chao et al, 34 no such relationship was found after accounting for the competing risk of death, which further strengthens our results. Thus, our findings better reflect the real estimated risk of ischemic stroke in a nationwide, unselected dialysis population.…”

Section: Discussionsupporting

confidence: 84%

Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation

Shih

Chao

et al. 2016

Circulation

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Background-Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. , and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76-2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45-1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA 2 DS 2 -VASc score for ischemic stroke was diminished in the competing-risk model. Conclusions-The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.

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Section: Discussionsupporting

confidence: 84%

Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation

Shih

Chao

et al. 2016

Circulation

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“…In the Taiwan nationwide cohort enrolling AF patients with ESRD, the overall incidences of stroke/TE were higher on the basis of both scores, compared with those observed in other cohorts [12]. In the cohort of Japanese non-valvular paroxysmal AF patients who were not receiving anticoagulation therapy, the event rates were even higher at CHADS 2 of 3, ≥ 4, and CHA 2 DS 2 -VASc of 5, ≥ 6 [14].…”

Section: Event Ratesmentioning

confidence: 80%

“…Following this, 201 were excluded by reviewing title or abstract and full texts of the remaining 37 articles were retrieved for further review if they met the predetermined criteria. Finally, six eligible studies were identified and included in the present metaanalysis [12][13][14][15][16][17]. The literature search flow diagram is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…In the present study, data from 31,539 AF patients (15,271 females, 48.4%) were pooled for further analyses. Among these studies, two population cohorts were from Taiwan nationwide database, focusing on non-valvular AF patients [15], and AF patients with end-stage renal dysfunction (ESRD) [12], respectively. In the Japanese study of Suzuki et al, data were pooled from Shinken Database, J-RHYTHM Registry, and Fushimi AF Registry to identify the ischemic stroke rates in Japanese non-valvular AF patients without anticoagulant therapy [17].…”

Section: Study Characteristicsmentioning

confidence: 99%

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The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis

Xiong

Chen

Senoo

et al. 2015

International Journal of Cardiology

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“…The diagnosis of end‐stage renal disease requiring dialysis in our present study was confirmed by both specific ICD‐9‐CM or ICD‐10‐CM codes and enrollment in the Registry of Catastrophic Illness Patient Database, a subpart of the National Health Insurance database. Only patients with end‐stage renal disease on dialysis can be registered in the Registry of Catastrophic Illness Patient Database according to the rules of the National Health Insurance system 13, 14…”

Section: Methodsmentioning

confidence: 99%

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Chan

See

et al. 2018

JAHA

116

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BackgroundWhether non–vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin among Asians with nonvalvular atrial fibrillation remains unclear.Methods and ResultsIn this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, there were 5843, 20 079, 27 777, and 19 375 nonvalvular atrial fibrillation patients taking apixaban, dabigatran, rivaroxaban and warfarin, respectively, from June 1, 2012 to December 31, 2016. Propensity‐score weighting was used to balance covariates across study groups. Patients were followed until the first occurrence of any efficacy or safety outcome or the end date of study. Hazard ratios (95% confidence intervals) comparing apixaban, dabigatran, and rivaroxaban with warfarin were: ischemic stroke/systemic embolism (IS/SE), 0.55 (0.43–0.69), 0.82 (0.68–0.98), and 0.81 (0.67–0.97); major bleeding, 0.41 (0.31–0.53), 0.65 (0.53–0.80), and 0.58 (0.46–0.72); and all‐cause mortality, 0.58 (0.51–0.66), 0.61 (0.54–0.68), and 0.57 (0.51–0.65). A total of 3623 (62%), 17 760 (88%), and 26 000 (94%) patients were taking low‐dose apixaban (2.5 mg twice daily), dabigatran (110 mg twice daily), and rivaroxaban (10–15 mg once daily), respectively. Similar to all‐dose NOACs, all low‐dose NOACs had lower risk of IS/SE, major bleeding, and mortality when compared with warfarin. In contrast to other standard‐dose NOACs, apixaban was associated with lower risks of IS/SE (0.45 [0.31–0.65]), major bleeding (0.29 [0.18–0.46]), and mortality (0.23 [0.17–0.31]) than warfarin.ConclusionsAll NOACs were associated with lower risk of IS/SE, major bleeding, and mortality compared with warfarin in the largest real‐world practice among Asians with nonvalvular atrial fibrillation. All low‐dose NOACs had lower risk of IS/SE, major bleeding, and mortality when compared with warfarin. Standard‐dose apixaban caused a lower risk of IS/SE, major bleeding, and mortality compared with warfarin.

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Incidence and prediction of ischemic stroke among atrial fibrillation patients with end-stage renal disease requiring dialysis

Cited by 74 publications

References 32 publications

Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation

Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation

The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

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