Real world data of anticoagulant treatment in non-valvular atrial fibrillation across renal function status

Abstract

The objective is to assess the impact of anticoagulant treatment in non-valvular atrial fibrillation (AF) and different categories of renal dysfunction in real world. Electronic Health recordings of patients with diagnosis of AF and renal function collected throughout 5 years and classified according to KDIGO categories. Stroke, transitory ischemic attack (TIA), intracranial hemorrhage and all-cause mortality were identified. Anticoagulant treatments during the study period were classified in untreated (never received therapy), VKA, NOAC and Aspirin. The risk of events was calculated by Cox-proportional hazard models adjusted by confounders. A total of 65,734 patients with AF, mean age 73.3 ± 10.49 years old and 47% females and follow-up of 3.2 years were included. KDIGO classification were: G1 33,903 (51.6%), G2 17,456 (26.6%), G3 8024 (12.2%) and G4 6351 (9.7%). There were 8592 cases of stroke and TIA, 437 intracranial hemorrhage, and 9603 all-cause deaths (incidence 36, 2 and 38 per 103 person/year, respectively). 4.1% of patients with CHA2DS2-VASc Score 2 or higher did not receive anticoagulant therapy. Risk of stroke, TIA, and all-cause mortality increased from G1 to G4 groups. Anticoagulant treatments reduced the risk of events in the four categories, but NOAC seemed to offer significantly better protection. Renal dysfunction increases the risk of events in AF and anticoagulant treatments reduced the risk of stroke and all-cause mortality, although NOAC were better than VKA. Efforts should be done to reduce the variability in the use of anticoagulants even in this high risk group.

Oral Anticoagulation in Patients with Chronic Kidney Disease and Non-Valvular Atrial Fibrillation: The FAERC Study

“…DOACs have proven beneficial in reducing the number of cardioembolic and haemorrhagic events in the general population, in both clinical trials and real-life studies [ 16 , 17 , 18 , 19 , 20 , 21 ]. The evidence in patients with CKD was obtained exclusively from sub-analyses of the cited studies, in which a clear benefit was shown up to a clearance of 30 mL/min, but with contradictory evidence at lower levels [ 22 , 23 , 24 ].…”

Vorhofflimmern – Was ist bei chronischer Nierenerkrankung und Hämodialyse zu beachten?

“…Interessanterweise ist die reduzierte Dosis von Apixaban nicht mit einem niedrigeren Blutungsrisiko vergesellschaftet. In einer Real-World-Studie mit < 65000 Teilnehmern war über die CKD Stadien (1-4) ein Vorteil für NOAKs gegenüber VKA zu sehen [12].…”