| Summary: | 碩士 === 國立成功大學 === 臨床藥學與藥物科技研究所 === 102 === Although warfarin is generally recommended for stroke prevention in atrial fibrillation (AF) patients, the effectiveness and safety of warfarin in dialysis patients remains controversial. In order to investigate the associations between warfarin use and risk of stroke or mortality, we conducted a retrospective cohort study of chronic dialysis patients aged 18 years and older with diagnosis of AF by using Taiwan’s National Health Insurance claims database. The exposure of warfarin was treated as a time-dependent variable during follow-up period. Time-dependent COX proportional modeling and propensity score matching were used to study the association among warfarin exposure and risk of stroke or mortality. Among 3,463 dialysis patients with AF, 522 (15.07%) filled a prescription for warfarin. Compared to warfarin non-exposure, warfarin exposure was not associated with statistically significant reduction in risk for stroke or mortality (HR 0.88; 95% CI 0.69 to 1.14). Similar results were obtained after propensity score matching. These results suggest that warfarin use is not beneficial in reducing risk of stroke or mortality in Taiwanese chronic dialysis patients with AF. Further analyses with adequately controlled confounders are needed to determine the risk and benefit of warfarin therapy in these patients.
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