Impact of restarting warfarin therapy in renal disease anticoagulated patients with gastrointestinal hemorrhage

Figures & data

Table 1. Baseline characteristics of the patient population.

	Non CKD or ESRD (n = 1074)	CKD (n = 159)	ESRD (n = 96)	p-Value
Variables
Age	75.0 ± 10.6	73.9 ± 10.8	77.2 ± 10.6	0.07
Women	515 (47.6%)	54 (33.9%)	30 (31.3%)	<0.0001
Race White	674 (62.8%)	59 (37.1%)	43 (44.7%)	<0.0001
Blacks	247 (22.9%)	85 (53.5%)	35 (36.4%)	<0.0001
Comorbidities
Hypertension	956 (89.0%)	153 (96.2%)	90 (93.7%)	0.001
Diabetes	324 (30.0%)	72 (45.2%)	48 (50%)	<0.0001
Cancer	75 (6.7%)	29 (18.2%)	13 (13.5%)	<0.0001
Liver disease	44 (4.1%)	9 (5.7%)	6 (6.25%)	0.06
Peripheral vascular disease	122 (11.3%)	39 (24.5%)	24 (25%)	<0.0001
CHADS2 Score	3 (2–5)	3 (2–5)	4 (2–5)	<0.0001
HASBLED score	3 (1–6)	3 (2–6)	3 (2–6)	<0.0001
Previous GIB	129 (12%)	35 (22%)	20 (21.2%)	<0.0001
Dyslipidemia	283 (26.2%)	63 (39.6%)	19 (19.8%)	<0.0001
Previous coronary artery disease	111 (10.2%)	41 (25.8%)	21 (21.8%)	<0.0001
Previous stroke/TIA	281 (26.0%)	67 (42.1%)	50 (52.1%)	<0.0001
INR at GIB	2.8 ± 0.9	2.4 ± 0.6	2.4 ± 0.8	0.08
Alcohol use	106 (9.8%)	10 (6.3%)	8 (8.3%)	0.14
NSAID use	71 (6.7%)	14 (8.8%)	8 (8.3%)	0.19
PPI use	114 (10.6%)	56 (35.2%)	21 (21.8%)	<0.0001
H2 blocker use	42 (3.9%)	13 (8.2%)	2 (2.1%)	0.008
Antiplatelet use	24 (2.2%)	7 (4.4%)	3 (3.2%)	0.13
Aspirin use	247 (22.9%)	52 (32.7%)	24 (25%)	0.009
Charlson comorbidity index	2.3 ± 1.8	3.1 ± 2.4	3.2 ± 2.9	<0.0001

Notes: PPI; proton pump inhibitor use, NSAID; non steroidal anti-inflammatory drug, INR; international normalized ratio, TIA; transient ischemic attack, GIB; gastrointestinal bleeding.

Figure 1. Kaplan Meier’s survival curve of patients who were restarted on warfarin with normal kidney function (broken line) and chronic kidney disease patients (solid line).

Figure 2. Kaplan Meier's survival curve of patients with chronic kidney disease that were restarted on warfarin (broken line) versus chronic kidney disease patients who were not restarted on warfarin (solid line).

Table 2. Risk of various outcomes in CKD patients.

	CKD restarted HR (95% CI)	Normal restarted HR (95% CI)	p-Value	CKD restarted HR (95% CI)	CKD not restarted HR (95% CI)	p-Value
GIB	1.00 (0.51–2.00)	1	0.98	2.50 (0.85–7.28)	1	0.01
Thromboembolism	0.97 (0.71–1.33)	1	0.86	0.06 (0.02–0.16)	1	0.0001
All – cause Mortality	1.06 (0.96–1.15)	1	0.25	0.70 (0.46–1.07)	1	0.10

Notes: GIB; recurrent gastrointestinal bleeding, CKD; chronic kidney disease, HR; hazard ratio, CI; confidence interval.

Figure 3. Kaplan Meier’s survival curve of patients who were restarted on warfarin with normal kidney function (broken line) and end stage renal disease patients on hemodialysis (solid line).

Figure 4. Kaplan Meier's survival curve of patients with end stage renal disease patients on hemodialysis that were restarted on warfarin (broken line) versus end stage renal disease patients on hemodialysis that were not restarted on warfarin (solid line).

Table 3. Risk of various outcomes in ESRD patients.

	ESRD restarted HR (95% CI)	Normal restarted HR (95% CI)	p-Value	ESRD restarted HR (95% CI)	ESRD not restarted HR (95% CI)	p-Value
GIB	1.12 (0.99–1.26)	1	0.07	1.72 (1.29–2.30)	1	0.0001
Thromboembolism	0.70 (0.45–1.1)	1	0.12	0.44 (0.27–0.73)	1	0.002
All – cause Mortality	0.77 (0.52–1.14)	1	0.19	0.22 (0.13–0.40)	1	0.0001

Notes: GIB; recurrent gastrointestinal bleeding, ESRD; end stage renal disease on dialysis, HR; hazard ratio, CI; confidence interval.