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Comment & Response
June 25, 2014

Influence of Chronic Kidney Disease on Warfarin Therapy for Atrial Fibrillation—Reply

Author Affiliations
  • 1Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
  • 2Division of Cardiology, Karolinska Institutet, Stockholm, Sweden
JAMA. 2014;311(24):2542-2543. doi:10.1001/jama.2014.5587

In Reply In our observational analysis, we reported outcomes associated with warfarin exposure in consecutive patients with atrial fibrillation surviving a myocardial infarction index event. Our data reflect Swedish clinical practice patterns in 2003 to 2010, which may not be the same as those in other parts of the world, other periods, or other populations.

Drs Vaduganathan and Greene were surprised by the low percentage of patients with atrial fibrillation who were prescribed warfarin in our study. There may have been an underuse of warfarin in patients with atrial fibrillation during this period, as previously documented.1,2 However, the proportion of patients with a CHADS2 score of 2 and higher or with bleeding risk factors (age, hypertension, CKD, or previous stroke) was similar between groups, arguing against patient selection.

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