Secondary stroke prophylaxis in atrial fibrillation patients with chronic kidney disease: a nationwide cohort study

EP Europace ◽  
2019 ◽  
Vol 22 (5) ◽  
pp. 716-723
Author(s):  
Mathias Aagaard Christensen ◽  
Emil Loldrup Fosbøl ◽  
Anders Nissen Bonde ◽  
Jonas Bjerring Olesen ◽  
Gunnar H Gislason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ischaemic Stroke ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulation ◽  
Multivariable Analysis ◽  
Thromboembolic Events ◽  
Post Stroke ◽  
Significant Difference

Abstract Aims Oral anticoagulation (OAC) therapy as secondary stroke prophylaxis in atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unexplored and poses a clinical treatment dilemma. We assessed the long-term risk of thromboembolic events according to post-stroke OAC therapy in AF patients with CKD after their first ischaemic stroke. Methods and results We identified Danish AF patients with CKD who presented with first-time ischaemic stroke from 2005 to 2014. Chronic kidney disease was defined as a diagnosis code for CKD before baseline, defined as 100 days after stroke discharge. Post-stroke antithrombotic therapy (OAC therapy and antiplatelet therapy) was identified from prescription claims from discharge to baseline. Cumulative incidences and adjusted hazard ratios (HRs) of thromboembolic events according to post-stroke OAC therapy were examined. Of 1252 AF patients with CKD presenting with ischaemic stroke, 631 (50.4%) patients were on OAC therapy and 621 (49.6%) were on antiplatelet therapy alone at baseline [median age 76 (interquartile range, IQR 71–83) and 80 (IQR 72–86), respectively]. The median follow-up period was 1.9 years (IQR 0.8–3.6). Cumulative incidence rates of thromboembolic events and bleeding showed no significant difference between those on OAC therapy and antiplatelet therapy. The results from the multivariable analysis revealed similar results: thromboembolic risk was not modified by OAC treatment [adjusted HR 0.89, 95% confidence interval (CI) 0.73–1.09] nor was the risk of bleeding (adjusted HR 0.88, 95% CI 0.67–1.17). Conclusion Oral anticoagulation in patients with CKD and prior stroke was not associated with a reduced risk of recurrent thromboembolic events compared with antiplatelet therapy.

scholarly journals Oral anticoagulation in chronic kidney disease with atrial fibrillation

2021 ◽  
Author(s):  
Pablo Gomez -Fernández ◽  
Antonio Martín Santana ◽  
Juan de Dios Arjona Barrionuevo
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulation

scholarly journals Ischaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis

EP Europace ◽  
2015 ◽  
Vol 18 (5) ◽  
pp. 665.1-671 ◽  
Author(s):  
Pak-Hei Chan ◽  
Duo Huang ◽  
Pok-Siu Yip ◽  
Jojo Hai ◽  
Hung-Fat Tse ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Ischaemic Stroke

Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist’s perspective

2020 ◽  
Vol 33 (3) ◽  
pp. 483-495 ◽  
Author(s):  
Maura Ravera ◽  
Elisabetta Bussalino ◽  
Maria Fusaro ◽  
Luca Di Lullo ◽  
Filippo Aucella ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulation

The Quandary of Oral Anticoagulation in Patients With Atrial Fibrillation and Chronic Kidney Disease

2016 ◽  
Vol 117 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Shmuel Schwartzenberg ◽  
Eli I. Lev ◽  
Alexander Sagie ◽  
Asher Korzets ◽  
Ran Kornowski
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulation

Abstract 4580: Proteinuria and Reduced Glomerular Filtration Rate Independently Increase Risk of Thromboembolism in Atrial Fibrillation: The ATRIA Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alan S Go ◽  
Margaret C Fang ◽  
Natalia Udaltsova ◽  
Yuchiao Chang ◽  
Leila H Borowsky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Stroke Risk ◽  
Thromboembolic Events ◽  
Stroke Risk Factors

Atrial fibrillation (AF) substantially increases the risk of ischemic stroke but this risk varies among patients with AF. Existing stroke risk stratification schemes have limited predictive ability. Chronic kidney disease is a major cardiovascular risk factor, but whether it independently increases the risk for stroke in AF is unknown. In a large, diverse cohort of adults with nonvalvular atrial fibrillation, we examined how chronic kidney disease (i.e., reduced glomerular filtration rate or proteinuria) affects risk of thromboembolism off anticoagulation in patients with AF. We estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation and proteinuria from urine dipstick results found in laboratory databases. Data on patient characteristics, stroke risk factors, longitudinal use of warfarin therapy, and thromboembolic events between 1996 –2003 were ascertained from validated clinical databases. Thromboembolic events (ischemic stroke and other systemic embolism) were confirmed by chart review. We used multivariable Poisson regression to evaluate the independent association between reduced eGFR and documented proteinuria with risk of thromboembolic events off warfarin therapy. During 33,165 person-years off anticoagulation among 13,535 patients with AF and no prior dialysis or renal transplant, we observed 676 incident thromboembolic events. After adjustment for known risk factors for stroke and level of eGFR, proteinuria increased the risk of thromboembolism by 54% (adjusted relative risk [RR] 1.54, 1.28 to 1.84). Independent of proteinuria and other confounders, there was a graded, increased risk of stroke associated with progressively lower eGFR compared with eGFR ≥60 (in units of ml/min/1.73 m 2 ): adjusted RR 1.16 (95% CI: 0.95 to 1.40) for eGFR 45– 59, and RR 1.39 (1.12 to 1.71) for eGFR <45 (P=0.001 for trend). Chronic kidney disease increases the risk of thromboembolism in AF independent of other stroke risk factors. Knowing the level of kidney function and presence of proteinuria can potentially improve risk stratification for decision-making about the use of antithrombotic therapy for stroke prevention in AF.

Abstract 13927: Advanced Age and Preferential Use of Vitamin K Antagonists in Severe Renal Impairment: First Results of the XARENO Registry in Patients With Non-valvular Atrial Fibrillation and Non-dialysis Dependent Advanced Chronic Kidney Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Reinhold Kreutz ◽  
Gilbert Deray ◽  
Juergen Floege ◽  
Marianne Gwechenberger ◽  
Andreas Luft ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Vitamin K ◽  
Severe Renal Impairment ◽  
Vitamin K Antagonists ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
First Results

Introduction: Patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) are at increased risk for both ischemic stroke and hemorrhage. In addition, treatment with vitamin K antagonists (VKA) has been associated with worsening of renal function compared to direct oral anticoagulants (DOACs). XARENO (Factor XA -inhibition in RENal patients with non-valvular atrial fibrillation Observational registry) is an ongoing prospective, non-interventional, observational study conducted in Europe. XARENO evaluates the effectiveness of rivaroxaban in preserving renal function and preventing thromboembolic events as compared to VKA in NVAF patients with CKD in clinical practice. Methods: XARENO included male and female NVAF patients ≥18 years old with an estimated glomerular filtration rate (eGFR) between 15 and 49 mL/min per 1.73 m 2 and an indication for anticoagulation. Enrolment took place from April 2016 until January 2020. Patients treated with either rivaroxaban or VKA were included, while patients in whom physicians were withholding any anticoagulation could be also enrolled. Minimal planned follow-up is one year. Primary observational outcomes include efficacy and safety outcomes (progression of CKD, stroke, other thromboembolic events, major cardiovascular events, major bleeding, and all-cause mortality). First results on outcomes in the full cohort are expected in 2021. Results: In this analysis of a first set of 1485 patients (56.1% males), 731 and 666 patients received rivaroxaban and VKA, while 88 patients did not receive any anticoagulation. Mean age at baseline was 77.3 years (67.5% older than 75 years) with a mean eGFR of 38.9 mL/min per 1.73 m 2 . Overall 74.7% of patients had eGFR values below 45 mL/min per 1.73 m 2 and 28.0% below 30 mL/min per 1.73 m 2 . In the latter group, use of a VKA was about twofold more frequent compared to rivaroxaban. Conclusions: This first analysis of XARENO patients reveals the very high age of NVAF patients with concomitant non-dialysis dependent advanced CKD and a preferential use of VKA in stage 4 CKD. XARENO aims to provide important information on the real-world effectiveness and safety of rivaroxaban compared with VKA for this vulnerable patient group.

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