Efficacy and Safety of Oral Anticoagulants in Patients with Atrial Fibrillation and Stages 4 or 5 Chronic Kidney Disease.
Am J Med. 2019 Jul 03;:
Authors: Chang SH, Wu CV, Yeh YH, Kuo CF, Chen YL, Wen MS, See LC, Huang YT
PURPOSE: The aim of this study was to investigate whether oral anticoagulants can provide efficacy and safety profiles better than no anticoagulant in patients with stages 4 or 5 chronic kidney disease and atrial fibrillation.
METHODS: From 2001 to 2017, a cohort of patients with stages 4 or 5 chronic kidney disease and atrial fibrillation based on electronic medical records were selected from Chang Gung Memorial Hospital system in Taiwan. Patients were divided into nonvitamin K antagonist oral anticoagulants (NOACs), warfarin, and non-anticoagulated groups. They were followed from the index date to the occurrence of the study outcomes, or for five years, whichever occurred first. The outcomes were admissions due to ischemic stroke or systemic embolism or major bleedings. Survival analyses were conducted to estimate the incidence rates of outcomes.
RESULTS: A total of 3771 patients with atrial fibrillation and estimated glomerular filtration rate less than 30ml/min/1.73m2 were enrolled, of whom 2971 were in the non-anticoagulated, 280 in the NOAC, and 520 in the warfarin groups. About 25% of all subjects (940 patients) were on dialysis. The mean follow-up was 3.2years. After adjusting for sex, age, comorbidities, and co-medication, the warfarin group had a significantly higher risk of ischemic stroke or systemic embolism (adjusted hazard ratio [aHR] 3.1, 95% confidence interval [CI] 2.1-4.6) than the non-anticoagulated group. The NOAC group had a similar risk of ischemic stroke or systemic embolism (aHR 1.1; 95% CI 0.3-3.4) to that of the non-anticoagulated group. Both the warfarin and the NOAC groups had a significantly higher major bleeding risk than the non-coagulated group (aHR 2.8 [95% CI: 2.0-3.8] for warfarin; aHR 3.1 [95% CI: 1.9-5.2] for NOAC).
CONCLUSION: The use of NOACs or warfarin is not more effective than using no anticoagulants at all in reducing the risk of ischemic stroke or systemic embolism. Both NOACs or warfarin are associated with increased risk of major bleeding. Our results do not support the use of anticoagulants in patients with atrial fibrillation and stages 4-5 chronic kidney disease.
PMID: 31278930 [PubMed - as supplied by publisher]