Anti-platelet or anti-coagulant agent for the prevention of ischemic stroke in patients with end-stage renal disease and atrial fibrillation-A nation-wide database analyses

- In our nation-wide cohort analyses, the incidence of non-valvular AF was 6% in patients with ESRD.
- With a study population of 4899 patients, the stroke rates were similar in our 3 study groups in a mean follow-up of 4.12 years.
- Anti-platelet or warfarin treatment could not reduce the incidence of new ischemic cerebral accident in ESRD patients with non-valvular AF.
- Using propensity score analysis to match differences in baseline characteristics, we got similar conclusion.

ObjectiveThe risk/benefit profiles of anti-coagulant or anti-platelet agents in patients with end-stage renal disease (ESRD) and atrial fibrillation (AF) remained unclear. We aimed to investigate the stroke risks in these patients with or without anti-coagulant/anti-platelet therapy by using our national database.MethodBy using our national health insurance ESRD claim database, we searched patients with AF, more than 18 years old and without prior history of ischemic stroke. Medication information as well as the events of ischemic stroke, hemorrhagic stroke, and transient ischemic accident during follow-up were identified from the database. Propensity score method was used to match all the potential confounders between patients with and without anti-platelets/warfarin treatment.ResultA total of 134,410 ESRD patients were identified in the database. Among them, patients with non-valvular AF, over 18 years old, without prior history of ischemic stroke and received monotherapy with anti-platelets (1622) or warfarin (294) served as case groups while patients (2983) without taking any anti-platelets and warfarin served as control groups. The incidences of ischemic stroke or transient ischemic attack (TIA) were not different among the control (6.6%), anti-platelet (6.2%) and warfarin (5.1%) groups in a follow-up period of approximately 4 years. The results remained unchanged after propensity match. Cox-regression analyses also showed no beneficial effect of anti-platelet or warfarin therapy in overall and any subgroups.ConclusionIn this nationwide cohort analyses, we found that anti-platelet or warfarin treatment could not lower the risk of ischemic stroke in patients with ESRD.