Supplementary Material for: Patients' Characteristics Affect the Survival Benefit of Warfarin Treatment for Hemodialysis Patients with Atrial Fibrillation. A Historical Cohort Study

Background: Stroke prevention in dialysis-dependent patients with atrial fibrillation (AF) is an unresolved clinical dilemma. Indeed, no randomized controlled trial evaluating the efficacy and safety of oral anticoagulants in this population, has been conducted so far. Observational research on the use of warfarin in patients on dialysis has shown conflicting results. This uncertainty is mirrored by the wide variations in warfarin prescription patterns across centers. We sought to evaluate the association between the use of vitamin K antagonists (VKAs) and mortality among hemodialysis patient with AF and to assess potential factors affecting the risk-benefit profile of warfarin in this population. Methods: A total of 91,987 patients registered in the European Clinical Dialysis Database® system from January 2004 to January 2015. Of which, 9,238 patients were identified with a diagnosis of AF. After excluding ineligible patients, a 1:1 propensity score matched cohort of 1,324 warfarin users and non-users were assembled. Results: VKA use was associated with both increased 90-day survival (hazard ratio, HR 0.47, p Conclusion: VKA may provide an early survival benefit; however, this is partially offset later during the follow-up. In addition, heterogeneous risk-benefit profiles were observed among subgroups of dialysis-dependent patients with AF, further emphasizing the complexities of tailoring stroke prevention strategies in this population.背景：依赖透析的心房颤动（atrial fibrillation，AF）患者的卒中预防仍是尚未解决的临床难题。迄今为止，尚未有针对该人群口服抗凝药物的疗效与安全性开展的随机对照试验。针对透析患者使用华法林的观察性研究结果存在矛盾。这种不确定性也体现在不同中心华法林处方模式的巨大差异之中。本研究旨在评估维生素K拮抗剂（vitamin K antagonists，VKAs）的使用与心房颤动血液透析患者死亡率之间的关联，并分析影响该人群华法林风险-收益比的潜在因素。 方法：本研究纳入2004年1月至2015年1月期间在欧洲临床透析数据库®（European Clinical Dialysis Database®）系统中登记的共计91987例患者。其中，确诊心房颤动的患者共9238例。在排除不符合纳入标准的患者后，通过1:1倾向得分匹配法构建了1324例华法林使用者与非使用者的队列。 结果：维生素K拮抗剂的使用与90天生存率升高相关（风险比（hazard ratio，HR）=0.47，P 结论：维生素K拮抗剂可能为患者带来早期生存获益，但该获益在后续随访过程中会被部分抵消。此外，在依赖透析的心房颤动患者亚组中观察到了异质性的风险-收益特征，这进一步凸显了为该人群定制卒中预防策略的复杂性。