scholarly journals Optimal Rivaroxaban Dose in Asian Patients With Atrial Fibrillation and Normal or Mildly Impaired Renal Function

Stroke ◽  
2019 ◽  
Vol 50 (5) ◽  
pp. 1140-1148 ◽  
Author(s):  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
Jin-Hyung Jung ◽  
Seil Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Impaired Renal Function ◽  
Asian Patients

P4769Optimal rivaroxaban dose in Asian patients with atrial fibrillation and normal or mildly impaired renal function

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E.-K Choi ◽  
S R Lee ◽  
K D Han ◽  
J H Jung ◽  
S Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Major Bleeding ◽  
Impaired Renal Function ◽  
Gi Bleeding ◽  
Nonsignificant Trend ◽  
Off Label ◽  
Asian Patients

Abstract Background Although rivaroxaban 15 mg was only given to patients with creatinine clearance (CrCl) <50mL/min in the pivotal clinical trial, this dose has been commonly prescribed in Asian patients with non-valvular atrial fibrillation (AF) regardless of renal function. There is a paucity of information regarding the clinical outcomes of rivaroxaban 15 mg compared to rivaroxaban 20 mg in patients with CrCl ≥50mL/min. This study aimed to examine the effectiveness and safety of two doses of rivaroxaban in Asian patients with AF and CrCl ≥50mL/min. Methods Using the Korean National Health Insurance Service database, patients with AF and normal or mildly impaired renal function (CrCl ≥50mL/min) and naïve to rivaroxaban or warfarin were included from January 2014 to December 2016. Three separate 1:1 propensity score-matched cohorts were conducted: rivaroxaban 20 mg (R20) vs. warfarin (n=15,584), rivaroxaban 15 mg (R15) vs. warfarin (n=11,554), and R20 vs. R15 (n=10,392). Hazard ratios (HRs) for ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal (GI) bleeding, major bleeding, all-cause death, and composite clinical outcome were analyzed. Results Among the pooled total study population, mean age was 66.9±10.9 years, 62.2% were male, mean CHA2DS2-VASc score was 3.16±1.79, and mean CrCl was 83.6±42.0 mL/min (median 78.4 mL/min, IQR 67.7–91.0 mL/min). A substantial proportion (42.6%) of patients with CrCl ≥50 mL/min were prescribed off-label R15 for stroke prevention in the Korean AF population. Compared to warfarin, both R20 and R15 showed significantly lower risk for ischemic stroke, major bleeding (mainly through reduction of ICH), and all-cause death (Figure). Overall, both R20 and R15 had better results for the composite clinical outcome compared to warfarin (HR: 0.617, 95% CI: 0.550–0.691 for R20, and HR: 0.759, 95% CI: 0.675–0.853 for R15). Compared to off-label R15, on-label R20 showed a nonsignificant trend toward lower risks of ischemic stroke, hospitalization for GI bleeding, hospitalization for major bleeding, and all-cause death. Overall, on-label R20 had better results for the composite clinical outcome compared to off-label R15 in patients with CrCl ≥50 mL/min (HR: 0.852, 95% CI: 0.735–0.988). This benefit was consistently observed in patients aged ≥80 years and those <50 kg. In patients with CrCl 50–60 mL/min, R20 showed a nonsignificant trend toward a higher risk of hospitalization for major bleeding compared to R15 (HR: 1.828, 95% CI 0.994–3.452). Conclusions Among Asians with AF and CrCl ≥50mL/min, both R20 and R15 were associated with reduced risk of ischemic stroke, ICH, major bleeding, and all-cause death without significantly increased risk of GI bleeding compared with warfarin. In patients with CrCl ≥50mL/min, on-label R20 showed better results for the composite clinical outcome compared to off-label R15.

Association between impaired renal function and stroke outcome in patients with versus without atrial fibrillation

2018 ◽  
Vol 25 (8) ◽  
pp. 1041-1048 ◽  
Author(s):  
Y. Pan ◽  
J. Jing ◽  
W. Chen ◽  
Y. Wang ◽  
Y. He
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Impaired Renal Function ◽  
Stroke Outcome

Risk of Stroke, Bleeding, and Death in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 178-186
Author(s):  
Yoav Arnson ◽  
Moshe Hoshen ◽  
Adi Berliner-Sendrey ◽  
Orna Reges ◽  
Ran Balicer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Bleeding Risk ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stroke Death

Introduction: Atrial fibrillation (AF) and chronic kidney disease (CKD) are both associated with increased risk of stroke, and CKD carries a higher bleeding risk. Oral anticoagulation (OAC) treatment is used to reduce the risk of stroke in patients with nonvalvular AF (NVAF); however, the risk versus benefit of OAC for advanced CKD is continuously debated. We aim to assess the management and outcomes of NVAF patients with impaired renal function within a population-based cohort. Methods: We conducted a retrospective observational cohort study using ICD-9 healthcare coding. Patients with incident NVAF between 2004 and 2015 were identified stratified by CKD stage. We compared treatment strategies and estimated risks of stroke, death, or any major bleeding based on CKD stages and OAC treatment. Results: We identified 85,116 patients with incident NVAF. Patients with impaired renal function were older and had more comorbidities. OAC was most common among stage 2 CKD patients (49%) and least in stages 4–5 CKD patients (27.6%). Higher CKD stages were associated with worse outcomes. Stroke rates increased from 1.04 events per 100 person-years (PY) in stage 1 CKD to 3.72 in stages 4–5 CKD. Mortality increased from 3.42 to 32.95 events/100 PY, and bleeding rates increased from 0.89 to 4.91 events/100 PY. OAC was associated with reduced stroke and intracranial bleeding risk regardless of CKD stage, and with a reduced mortality risk in stages 1–3 CKD. Conclusion: Among NVAF patients, advanced renal failure is associated with higher risk of stroke, death, and bleeding. OAC was associated with reduced stroke and intracranial bleeding risk, and with improved survival in stages 1–3 CKD.

Impact of Impaired Renal Function and Metabolic Syndrome on the Recurrence of Atrial Fibrillation after Catheter Ablation: A Long Term Follow-Up

2012 ◽  
Vol 35 (5) ◽  
pp. 532-543 ◽  
Author(s):  
ALEXANDER BERKOWITSCH ◽  
MALTE KUNISS ◽  
HARALD GREISS ◽  
MACIEJ WÓJCIK ◽  
SERGEY ZALTSBERG ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Metabolic Syndrome ◽  
Renal Function ◽  
Catheter Ablation ◽  
Impaired Renal Function ◽  
Long Term Follow Up

Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial

2012 ◽  
Vol 33 (22) ◽  
pp. 2821-2830 ◽  
Author(s):  
Stefan H Hohnloser ◽  
Ziad Hijazi ◽  
Laine Thomas ◽  
John H Alexander ◽  
John Amerena ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Impaired Renal Function ◽  
Bleeding Events ◽  
Disease Epidemiology ◽  
Increased Risk ◽  
Novel Oral Anticoagulant ◽  
Stroke Death

AbstractAimsAtrial fibrillation (AF) is common among patients with impaired renal function. Apixaban, a novel oral anticoagulant with partial renal excretion, was compared with warfarin and reduced the rate stroke, death and bleeding in the ARISTOTLE trial. We evaluated these outcomes in relation to renal function.Methods and resultsBaseline glomerular filtration rate (GFR) was estimated using the Cockcroft–Gault and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations as well as cystatin C measurements. According to baseline Cockcroft–Gault, there were 7518 patients (42%) with an estimated GFR (eGFR) of >80 mL/min, 7587 (42%) between >50 and 80 mL/min, and 3017 (15%) with an eGFR of ≤50 mL/min. The rate of cardiovascular events and bleeding was higher at impaired renal function (≤80 mL/min). Apixaban was more effective than warfarin in preventing stroke or systemic embolism and reducing mortality irrespective of renal function. These results were consistent, regardless of methods for GFR estimation. Apixaban was associated with less major bleeding events across all ranges of eGFRs. The relative risk reduction in major bleeding was greater in patients with an eGFR of ≤50 mL/min using Cockcroft–Gault {hazard ratio (HR) 0.50 [95% confidence interval (CI) 0.38–0.66], interaction P = 0.005} or CKD-EPI equations [HR 0.48 (95% CI 0.37–0.64), interaction P = 0.003].ConclusionIn patients with AF, renal impairment was associated with increased risk of cardiovascular events and bleeding. When compared with warfarin, apixaban treatment reduced the rate of stroke, death, and major bleeding, regardless of renal function. Patients with impaired renal function seemed to have the greatest reduction in major bleeding with apixaban.

Impaired Renal Function in Stroke Patients with Atrial Fibrillation

2014 ◽  
Vol 23 (5) ◽  
pp. 1225-1228 ◽  
Author(s):  
Eva-Maria Sauer ◽  
Roland Sauer ◽  
Bernd Kallmünzer ◽  
Christian Blinzler ◽  
Lorenz Breuer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Impaired Renal Function ◽  
Stroke Patients

Abstract 17202: Comparative Performance of the R 2 Chads 2 , Chads 2 , and Cha 2 Ds 2 -vasc Scores in Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Emily C O'Brien ◽  
DaJuanicia N Simon ◽  
Laine Thomas ◽  
Gregg C Fonarow ◽  
Peter R Kowey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Impaired Renal Function ◽  
Stroke Risk ◽  
Cox Proportional Hazards ◽  
Risk Scores ◽  
Systemic Embolism ◽  
Comparative Performance ◽  
Event Rates

Background . Existing scores to estimate stroke risk in atrial fibrillation (AF) have shown variable performance. We compared the predictive performance of the R 2 CHADS 2 score, which includes a term for renal dysfunction, to that of two existing stroke risk scores, CHADS 2 and CHA 2 DS 2 -VASc. Methods . We used data from the ORBIT-AF study, a national, prospective, outpatient registry of incident and prevalent AF in patients >18 years. We examined the association between impaired renal function (CrCl<60 mL/min) and 2-year risk of stroke/systemic embolism (SE) in separate Cox proportional hazards models with linear terms for CHADS 2 and CHA 2 DS 2 -VASc scores. We compared discrimination of the three scores using c-indices and evaluated calibration of R 2 CHADS 2 by comparing event rates in ORBIT to published rates from an external clinical trial population (ROCKET-AF) and an observational cohort (ATRIA). Results . We included N=9743 patients enrolled at 174 ORBIT-AF sites. The median age was 75 years (IQR 67-82), 89.5% were white, 42.5% were female, and 76.4% were taking oral anticoagulation (OAC). Over a median follow-up of 2 years, N=214 stroke/systemic embolism (SE) events occurred (1.00 per 100 pt.-years). Impaired renal function was present in 35.4% of patients and was associated (HR; 95% CI) with increased stroke/SE risk in unadjusted models (1.65; 1.27-2.14). This association was attenuated in models adjusting for CHADS 2 (1.21; 0.92, 1.60) or CHA 2 DS 2 -VASc (1.05; 0.79, 1.40). Discrimination (c-index; 95% CI) was similar for R 2 CHADS 2 , CHADS 2 and CHA 2 DS 2 -VASc; results were consistent by baseline OAC use (Table). Stroke/SE event rates in ORBIT were lower than those in two external populations for all levels of R 2 CHADS 2 . Conclusion: In a well-treated community patient population, renal dysfunction did not improve discrimination of traditional embolic risk models. Future studies examining the association between renal dysfunction and outcomes by type of OAC are needed.

scholarly journals Impact of Impaired Renal Function on the Incidence of Atrial Fibrillation following Radiofrequency Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter

2015 ◽  
Vol 45 (6) ◽  
pp. 473 ◽  
Author(s):  
Chang Hee Kwon ◽  
Jun Kim ◽  
Min Su Kim ◽  
Jae-Hyung Roh ◽  
Jin Hee Choi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Radiofrequency Ablation ◽  
Atrial Flutter ◽  
Impaired Renal Function ◽  
Cavotricuspid Isthmus

scholarly journals Impaired renal function is associated with recurrence after cryoballoon catheter ablation for paroxysmal atrial fibrillation: A potential effect of non-pulmonary vein foci

2017 ◽  
Vol 69 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Satoshi Yanagisawa ◽  
Yasuya Inden ◽  
Hiroyuki Kato ◽  
Aya Fujii ◽  
Yoshiaki Mizutani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Impaired Renal Function ◽  
Potential Effect

P391Estimated glomerular filtration rate levels and risk of stroke in individuals with diabetes mellitus and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Westreich ◽  
O Barrett ◽  
L Kezerle ◽  
M Leventer Roberts ◽  
M Avgil Tsadok ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Mortality Risk ◽  
Impaired Renal Function ◽  
Filtration Rate ◽  
Historical Cohort ◽  
Increased Risk

Abstract Funding Acknowledgements pfizer Background Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Chronic kidney disease (CKD) has been shown in some studies to increase the risk of stroke. This finding is not consistent among all studies. Therefore the relationship between kidney function, diabetes and stroke risk is complex and warrants further investigation. Purpose To assess the incidence rates and risk of ischemic stroke and mortality by baseline Estimated Glomerular Filtration Rate (eGFR) levels among individuals with AF and DM. Methods A prospective, historical cohort study using our electronic medical records database. The study population included all members 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to eGFR levels at the time of AF diagnosis: eGFR ≥ 60, between 30-60 and ≤ 30 or chronic dialysis or kidney transplant. Results A total of  17,567 cases were included in the final analysis, of them, 11013 (62.7%) had eGFR ≥ 60, 4930 (28%) with eGFR between 30-60 and 1624 (9.24%) with eGFR ≤30 . The median age was 75 years (IQR 65-83) with a majority of females in all groups, 52.5%, 51.2% and 55.5% respectively. The incidence of stroke per 100 person-years in the three study groups was: 1.88 in patients with eGFR ≥ 60, 2.69 in patients with eGFR between 30-60 and 3.34 in those with eGFR ≤ 30 . Impaired renal function was associated with increased risk of stroke in univariate analysis, but not found in the adjusted model  (Adjusted Hazard Ratio (AHR) = 1.04 {95% 0.89-1.23} for eGFR 30-60  and 1.16 {95% CI 0.88-1.51} for eGFR ≤ 30 compared to GFR ≥ 60). incidence of mortality per 100 person-years was 10.78 in patients with  eGFR ≥ 60, 21.49 in patients with eGFR 30-60 and 41.55 in those with eGFR ≤ 30. In both univariate and multivariate analyses, decreased levels of eGFR were associated with increased mortality risk compared to subjects with normal renal function (AHR 1.22 {95%CI 1.14-1.27} and AHR 2.09 {95%CI 1.95-2.24} for eGFR between 30-60 and for eGFR ≤ 30, respectively). Conclusion In this observational prospective cohort of patients with newly diagnosed NVAF, impaired renal function was not found to be associated with increased risk of stroke. Lower eGFR levels were associated with an increased mortality risk.

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