Net Clinical Benefit of Antithrombotic Therapy in Patients With Atrial Fibrillation and Chronic Kidney Disease

Abstract

CKD is associated with a higher risk of stroke/thromboembolism across stroke risk strata in AF patients. High-risk CKD patients (CHA₂DS₂-VASc ≥2) with AF benefit from warfarin treatment for stroke prevention.

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

“…Our finding of an increased risk of ischaemic stroke in patients with CKD‐no RRT is similar to previous findings from non‐HF populations 9, 25. As the aim of our study was to examine the prognostic value of CKD in relation to stroke, major bleeding, and mortality in HF, we can only speculate on the aetiological explanations for our observations.…”

“…Patients with CKD were identified using ICD‐10 codes in the Danish registries, which have also been used in previous registry‐based studies of patients with CKD 9, 25. However, we did not have access to biomarkers, and therefore, CKD could be under‐reported, as a measurement outside normal ranges might not necessarily trigger a diagnosis in the registries.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Stosowanie warfaryny wiązało się z neutralnym lub zwiększonym ryzykiem udaru mózgu w analizach baz danych obejmujących pacjentów dializowanych [419][420][421], w tym w analizie populacyjnej przeprowadzonej w Kanadzie (skorygowany HR udaru mózgu 1,14; 95% CI 0,78-1,67; skorygowany HR krwawienia 1,44; 95% CI 1,13-1,85) [422]. Natomiast dane z Danii wskazują na korzyści z OAC u pacjentów poddawanych leczeniu nerkozastępczemu [423]. Potrzebne są więc kontrolowane badania dotyczące stosowania leków przeciwzakrzepowych (zarówno VKA, jak i NOAC) u dializowanych pacjentów z AF [424].…”

Challenging the use of warfarin in patients on dialysis with atrial fibrillation

“…6 We therefore question what causes the observed differences between these studies (Table 1)? A central limitation of the study by Bonde et al, 2 and a previous study by the same research group, 7 is that the cohort of patients who were undergoing renal replacement therapy were exposed to dif ferent treatment modalities-some were on haemodialysis, some on peritoneal dialysis, and a considerable subgroup had received a kidney transplant. This cohort, therefore, combined patients with varying degrees of CKD and heparin exposure.…”

“…Nat. Rev 2 The original study and the commentary both conclude that anticoagulation with warfarin is safe and reduces the risk of stroke in patients with CKD, and even in dialysis patients. This latter point contrasts with three large registry studies which reported that patients with atrial fibril lation administered warfarin and under going haemodialysis have an increased risk of stroke.…”