Survival Benefit of Anticoagulation Therapy in End Stage Kidney Disease Patients with Atrial Fibrillation: A Single Center Retrospective Study

Background and Objectives: Although the need for anticoagulation to prevent thromboembolism is increasing and non-vitamin K antagonist oral anticoagulants (NOACs) have been tried, there is still controversy about the efficacy of anticoagulation in patients with dialysis. Materials and Methods: We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with atrial fibrillation (AF). We retrospectively analyzed all data of 89 patients who received dialysis therapy and were diagnosed with AF. Among them, 27 received anticoagulation (11 warfarin and 16 apixaban 2.5 mg twice a day), while 62 received no anticoagulation. Results: In multivariate Cox regression analysis, compared to no anticoagulation treatment, anticoagulation treatment was associated with a low incidence of all-cause mortality (hazard ratios (HR) 0.36; 95% confidence interval (CI) 0.15–0.88). Compared to no anticoagulation treatment, more anticoagulation treatment patients experienced severe bleeding (HR 4.67; 95% CI 1.26–17.25) and any bleeding (HR 2.79; 95% CI 1.01–7.74). Compared to no anticoagulation, warfarin treatment patients were associated with a low incidence of all-cause mortality (HR 0.26; 95% CI 0.09–0.81) and a high incidence of severe bleeding (HR 4.85; 95% CI 1.12–21.10). All-cause mortality and bleeding were not significantly different between no anticoagulation and apixaban treatment patients. Conclusions: In dialysis patients with AF, anticoagulation therapy is associated with an increased incidence of severe bleeding, but anticoagulation therapy is associated with a low incidence of all-cause mortality. Individualized anticoagulation therapy with careful bleeding monitoring is needed in dialysis patients with AF.

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458Real world persistence with direct oral anticoagulants in anticoagulation naive patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz747.0117 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Denas ◽

G Costa ◽

E Ferroni ◽

N Gennaro ◽

U Fedeli ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Cox Regression ◽

Anatomical Therapeutic Chemical ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Female Gender ◽

Population Based ◽

Real World Data

Abstract Introduction Anticoagulation therapy is central for the management of stroke in patients with non-valvular atrial fibrillation (NVAF). Persistence with oral anticoagulation is essential to prevent thromboembolic complications. Purpose To assess persistence levels of DOACs and look for possible predictors of treatment discontinuity in NVAF patients. Methods We performed a population-based retrospective cohort study in the Veneto Region (north-eastern Italy, about 5 million inhabitants) using the regional health system databases. Naïve patients initiating direct oral anticoagulants (DOACs) for stroke prevention in NVAF from July 2013 to September 2017 were included in the study. Patients were identified using Anatomical Therapeutic Chemical (ATC) codes, excluding other indications for anticoagulation therapy using ICD-9CM codes. Treatment persistence was defined as the time from initiation to discontinuation of the therapy. Baseline characteristics and comorbidities associated to the persistence of therapy with DOACs were explored by means of Kaplan-Meier curves and assessed through Cox regression. Results Overall, 17920 patients initiated anticoagulation with DOACs in the study period. Most patients were older than 74 years old, while gender was almost equally represented. Comorbidities included hypertension (72%), diabetes mellitus (17%), congestive heart failure (9%), previous stroke/TIA (20%), and prior myocardial infarction (2%). After one year, the persistence to anticoagulation treatment was 82.7%, while the persistence to DOAC treatment was 72.9% with about 10% of the discontinuations being due to switch to VKAs. On multivariate analysis, factors negatively affecting persistence were female gender, younger age (<65 years), renal disease and history of bleeding. Conversely, persistence was better in patients with hypertension, previous cerebral ischemic events, and previous acute myocardial infarction. Persistence to DOAC therapy Conclusion This real-world data show that within 12 months, one out of four anticoagulation-naïve patients stop DOACs, while one out of five patients stop anticoagulation. Efforts should be made to correct modifiable predictors and intensify patient education.

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MO757COMPARISON OF ANTI-COAGULATION AND NO ANTI-COAGULATION IN DIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A SINGLE CENTER RETROSPECTIVE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab097.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jun Young Lee ◽

Jae Won Yang ◽

Jae Seok Kim ◽

Seong Ok Choi ◽

Byoung Geun Han

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Dialysis Patients ◽

Dialysis Therapy ◽

Cox Regression Analysis ◽

Significant Difference ◽

Baseline Characteristics ◽

Stage Renal Disease ◽

End Stage ◽

Risk And Benefit

Abstract Background and Aims Atrial fibrillation (AF) is common arrhythmia in end stage renal disease patients. Although, the need of anticoagulation to prevent stroke and thromboembolism is increasing, the efficacy of anticoagulation is not proven in most of study. We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with AF. Method By using medical record, we retrospectively analyzed all data of 99 patients who received dialysis therapy and diagnosed AF. Results Among 99 patients who diagnosed AF with dialysis 36 patients received anticoagulation (17 coumadin, 19 apixaban 2.5mg bid), 63 patients received no anticoagulation. There was no significant difference of baseline characteristics between anticoagulation, and no anticoagulation patients. Although no anticoagulation group experienced more all-cause (39.7% vs 32.4%, p=0.572) and cardiovascular mortality (17.6% vs 10.8%, p=0.197) than anticoagulation group it was not statistically significant. Compared to apixaban 2.5mg bid patients, coumadin anticoagulation patients experienced more frequent mfig ajor adverse cardiovascular events (35.3% vs 15.8%, p=0.109) but it was not statistically significant in multi variate Cox regression analysis (Hazard ratio 1.143, 95% Confidence Interval 0.503-2.597). Conclusion Apixaban 2.5mg bid was not inferior than coumadin considering risk and benefit of anticoagulation in dialysis patients.

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P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i

European Heart Journal ◽

10.1093/eurheartj/ehz748.0633 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M I Gonzalez Del Hoyo ◽

G Cediel ◽

A Carrasquer ◽

G Bonet ◽

K Vasquez-Nunez ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Emergency Department ◽

Regression Analysis ◽

Troponin I ◽

Cox Regression ◽

Cox Regression Analysis ◽

All Cause Mortality

Abstract Background CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF. Purpose This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF. Methods A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE). Results A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint. Conclusions cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.

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6116Thromboembolic risk in infection-related atrial fibrillation: is infection or atrial fibrillation the sinner?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0142 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Gundlund ◽

J B Olesen ◽

J H Butt ◽

M A Christensen ◽

G H Gislason ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Admission ◽

Cox Regression ◽

Anticoagulation Therapy ◽

First Year ◽

Thromboembolic Events ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

Study Population ◽

Hospital Contact

Abstract Introduction Infection-related atrial fibrillation (AF) has been associated with similar risk of thromboembolic events as AF without a concurrent infection. However, it is unknown whether the increased thromboembolic risk in this patient group is primarily associated with AF or with the infection. Purpose We compared type of infection and 1-year outcomes in patients with AF during an infection and in patients with infection without AF. Methods By crosslinking data from Danish nationwide registries, AF naïve patients admitted with an infection from 1996–2016 were identified. Patients with infection-related AF (defined as patients who developed AF during their hospital admission with infection) were matched 1:3 on age, calendar year, sex, and type of infection (gastrointestinal infection, pneumonia, urinary tract infection, sepsis, and other infections) with those who had infection without AF. Cumulative incidences of thromboembolic events were calculated using the Aalen Johansen estimator and adjusted hazard ratios (HR) of thromboembolic events and hospital contacts with AF were assessed by multivariable Cox regression analysis comparing those with infection-related AF with those with infection without AF. Results The study population comprised 30,711 patients with infection-related AF and 92,133 patients with infection without AF (median age 79 years [interquartile range 71–86] and 47.6% males in both groups). In general, patients with infection-related AF had more concurrent diseases than patients with infection without AF. During the first week after the hospital admission, 9.8% of the patients with infection-related AF and 0.1% of the patients with infection without AF initiated oral anticoagulation therapy. During the first year after the infection, 7.6% of patients with infection-related AF and 4.4% of patients with infection without AF had a thromboembolic event, while 36.1% and 1.8% had a new hospital-contact with AF. Cumulative incidences of thromboembolic events are depicted in the Figure. In the multivariable models, infection-related AF was associated with an increased 1-year risk of thromboembolic events and new hospital contacts with AF compared with infection without AF (HR 2.05, 95% confidence interval (CI) 1.94–2.17 for thromboembolic events and HR 26.06, 95% CI 24.72–27.48 for new AF episodes, respectively). Conclusion More than one third of patients with infection-related AF had a new hospital contact with AF during the first year after their infection. Further, infection-related AF was associated with a significantly increased 1-year risk of thromboembolic events compared with infection without AF. Consequently, this study suggests that AF begets AF, even if it presents during an infection. Acknowledgement/Funding None

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Clinical application of the novel 4S-AF scheme for the characterisation of patients with atrial fibrillation: a report from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0440 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

W.Y Ding ◽

M Proietti ◽

G Boriani ◽

F Marin ◽

C Blomstrom-Lundqvist ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Left Atrial ◽

Thromboembolic Event ◽

Stroke Risk ◽

Cox Regression ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Atrial Enlargement

Abstract Background Current classification systems recommended by major international guidelines are based on a single domain of atrial fibrillation (AF): temporal pattern, symptom severity or underlying comorbidity. Lack of integration between these various elements limits our approach to patients with AF and acts as a barrier against the delivery of better holistic care. The 4S-AF classification scheme was recently introduced as a means for the characterisation of patients with AF. It comprises of 4 domains: stroke risk (St), symptoms (Sy), severity of AF burden (Sb) and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and effects of individual domains on outcomes in AF. Methods Patients with AF from 250 centres across 27 participating European countries were included. All patients were over 18 years old and had electrocardiographic confirmation of AF within 12 months prior to enrolment. Data on demographics and comorbidities were collected at baseline. Individual domains of the 4S-AF scheme were assessed using the CHA2DS2-VASc score (St), European Heart Rhythm Association classification (Sy), temporal classification of AF (Sb), and cardiovascular risk factors and the degree of left atrial enlargement (Su). Each of these domains were used during multivariable cox regression analysis. Results A total of 6321 patients were included in the present analysis, corresponding to 57.0% of the original cohort of 11096 patients. The median age of patients was 70 (interquartile range [IQR] 62–77) years with 2615 (41.4%) females. Among these patients, 528 (8.4%) had low stroke risk (St=0), 3002 (47.5%) no or mild symptoms (Sy=0), 2558 (40.5%) newly diagnosed or paroxysmal AF (Sb=0), and 322 (5.1%) no cardiovascular risk factors or left atrial enlargement (Su=0). Median follow-up was 24 months. Using multivariable cox regression analysis, independent predictors of all-cause mortality were (St) (adjusted hazard ratio [aHR] 8.21 [95% CI, 2.60–25.9]), (Sb) (aHR 1.21 [95% CI, 1.08–1.35]) and (Su) (aHR 1.27 [95% CI, 1.14–1.41]). For cardiovascular mortality and any thromboembolic event, only (Su) (aHR 1.73 [95% CI, 1.45–2.06]) and (Sy) (aHR 1.29 [95% CI, 1.00–1.66]) were statistically important, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Conclusion Overall, we demonstrated that the 4S-AF scheme may be used to provide clinical characterisation of patients with AF using routinely collected data, and each of the domains within the 4S-AF scheme were independently associated with adverse long-term outcomes of all-cause mortality, cardiovascular mortality and/or any thromboembolic event. FUNDunding Acknowledgement Type of funding sources: None.

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P1904Oral anticoagulation in patients undergoing elective cardioversion of atrial fibrillation. Real-life experience from Finland

European Heart Journal ◽

10.1093/eurheartj/ehz748.0651 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Itainen-Stromberg ◽

A.-M Hekkala ◽

A Aro ◽

T Vasankari ◽

J Airaksinen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Large City ◽

Real Life ◽

University Hospital ◽

Bleeding Complications ◽

Bleeding Events ◽

Hospital District ◽

Anticoagulation Treatment

Abstract Background Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The real-life data evaluating the safety and efficacy of ECV in patients receiving NOACs is sparse. Purpose The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications. Methods Consecutive AF patients undergoing ECVs in a large city in Finland between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute (<30 days) complications and regimen changes within one year were evaluated. Results Nine hundred patients (59.2% men; mean age, 68.0±10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA2DS2-VASc score was 2.5 (±1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 vs. 68 days, respectively; P<0.001). Furthermore, patients receiving NOAC had fewer postponements of scheduled elective cardioversion compared with warfarin (12.6% vs. 37.4%, respectively, P<0.001). The most common reason for visit cancellation was an imbalance of warfarin therapy and labile INR values. Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. All patients who experienced a stroke or TIA had adequate anticoagulation therapy for at least 3 weeks preceding the cardioversion, and both patients in the warfarin group had an INR value >2 when thromboembolic complications occurred. Clinically relevant bleeding events occurred in 3 patients (0.5%) receiving NOACs and 7 patients (1.8%) receiving warfarin. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs. Conclusion In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and fewer postponements of scheduled elective cardioversion compared with warfarin. Furthermore, patients receiving NOAC therapy had less anticoagulation treatment changes than patients on warfarin. Acknowledgement/Funding Finnish Foundation for Cardiovascular Research, Helsinki University Hospital District research fund, Boehringer-Ingelhem, Finnish Medical Foundation

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MO820INTRACELLULAR WATER BEFORE HEMODIALYSIS PREDICTS ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Robert Ekart ◽

Gasper Keber ◽

Nina Vodošek Hojs ◽

Eva Jakopin ◽

Nejc Piko ◽

...

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Cox Regression ◽

Volume Status ◽

Dialysis Patients ◽

Cox Regression Analysis ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Before And After

Abstract Background and Aims Several factors may be responsible for the increased mortality in dialysis patients, but volume overload is considered among the main mechanisms of this association. Volume status is usually estimated using clinical criteria, i.e., patien's signs and symptoms, peridialytic blood pressure measurements, and intradialytic hemodynamic instability. Bioimpedance analysis (BIA) is another way to measure volume status in dialysis patients. BIA can measure overhydration (OH), extracellular water (ECW), intracellular water (ICW) and ECW/ICW ratio. The aim of our study was to analyze the role of BIA parameters before and after hemodialysis (HD) on all-cause mortality. Method Eighty-three patients (mean age 64.2 years; 51 men) on maintenance HD were included. BIA was performed and blood pressure was measured before and after the HD session. Patients were followed for assigned time, until transplantation or death. The mean follow-up time was 1181±564 days. Results Descriptive statistics of our patients are shown in Table 1. During the follow-up period, 6 (7.2%) patients were transplanted and 39 (47%) patients died. Univariate Cox regression analysis showed that only ICW before HD was a significant predictor of all-cause mortality (HR=1.089; 95%CI: 1.01-1.17, p=0.018). OH, ECW, ECW/ICW ratio before and after HD and ICW after HD were not associated with survival. In multivariate Cox regression analysis including ICW before dialysis, age, dialysis vintage, pulse pressure before HD, hemoglobin, CRP and serum albumin, ICW before dialysis was an independent predictor of all-cause mortality (HR=1.102; 95%CI: 1.01-1.20, p=0.029) (Table 2). Conclusion ICW before HD predicts all-cause mortality in HD patients.

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Endothelial Haemostatic Factors May Be Associated with Mortality in Patients on Long-term Anticoagulant Treatment

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649784 ◽

1995 ◽

Vol 74 (02) ◽

pp. 612-615 ◽

Cited By ~ 7

Author(s):

Mats Brännström ◽

Jan-Håkan Jansson ◽

Kurt Boman ◽

Torbjörn K Nilsson

Keyword(s):

Cox Regression ◽

Oral Anticoagulants ◽

Fold Increase ◽

High Morbidity ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Von Willebrand ◽

Vascular Mortality ◽

Pai 1

SummaryThe aim of the present study was to test if long-term mortality could be predicted by endothelial derived haemostatic variables in a population with high morbidity due to thromboembolic disease. Plasma samples were drawn from 212 out-patients treated with oral anticoagulants, at the beginning of the study, and analyzed for mass concentration of tissue plasminogen activator (tPA) and its inhibitor (PAI-1), and von Willebrand factor. In the course of 3.8-year follow-up 45 patients died, including 38 vascular deaths. We found that all-cause mortality was significantly associated with increased levels of vWF and tPA. For vascular mortality there was a significant association with all three haemostatic variables (tPA, PAI-1, vWF). For vWF there was a 3-fold increase in total and vascular mortality in the highest quartile compared to the lowest quartile. There were 27 vascular deaths in the group of patients with a tPA-value above the median compared to 11 in those with a tPA below the median. In multivariate Cox regression analysis (including: age, sex, smoking habits, body mass index, diabetes mellitus, hypertension, tPA, PAI-1, and vWF), vWF and smoking were independently significantly associated with all-cause mortality, and tPA and age with vascular mortality. Endothelial derived haemostatic variables are predictors of total and vascular mortality in patients treated with oral anticoagulants.

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Direct oral anticoagulation and mortality in moderate to high-risk atrial fibrillation

Heart ◽

10.1136/heartjnl-2018-314476 ◽

2019 ◽

Vol 105 (19) ◽

pp. 1487-1492 ◽

Cited By ~ 1

Author(s):

Ronen Arbel ◽

Ruslan Sergienko ◽

Ariel Hammerman ◽

Sari Dotan-Greenberg ◽

Erez Batat ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Lower Risk ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Treated Group ◽

Newly Diagnosed ◽

Risk Of Death ◽

All Cause Mortality

ObjectiveAlthough direct oral anticoagulants (DOAC) are the recommended antithrombotic therapy for patients with non-valvular atrial fibrillation (NVAF), anticoagulation in patients with NVAF is still inadequate. The effect of withholding DOAC therapy on patient survival is unknown. Therefore, our objective was to compare all-cause mortality rates between DOAC-treated patients with NVAF and similar patients receiving no anticoagulation.MethodsWe performed a retrospective cohort study analysing Clalit Health Services’ extensive electronic database, regarding all newly diagnosed, anticoagulant-naïve patients with NVAF who were eligible for DOAC therapy from 1 January 2011 to 31 December 2016. Patients who received DOAC therapy were matched by propensity scoring to patients receiving no anticoagulation. The primary outcome was all-cause mortality. Final patient follow-up date was 15 May 2017.Results18 901 eligible patients were identified. 8298 received treatment with a DOAC and 10 603 received no anticoagulation therapy. Of those, 5657 patients who received DOAC therapy were matched with 5657 patients who did not receive any anticoagulant. Death occurred in 715 patients in the DOAC-treated group (7.6% per year) and in 2075 patients in the non-anticoagulated patient group (11.1% per year). DOAC therapy was associated with significantly lower risk for all-cause mortality (HR=0.69, 95% CI 0.63 to 0.75, p<0.001). The benefit of DOAC therapy was demonstrated across all subgroups analysed.ConclusionsIn this cohort of newly diagnosed patients with NVAF, DOAC therapy was associated with a significantly lower risk of death compared with no oral anticoagulation. Our findings provide further evidence for the importance of providing DOAC anticoagulation in patients with NVAF.

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Differential effect of anticoagulation therapy in patients older versus younger than 80 years with atrial fibrillation and severe chronic kidney disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.3220 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Fortuny Frau ◽

S Raposeiras-Roubin ◽

J.M Andreu-Cayuelas ◽

A Garcia-Egido ◽

C Ortiz-Cortes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cox Regression ◽

Anticoagulation Therapy ◽

Funding Source ◽

Bleeding Events ◽

Younger Patients ◽

Cox Regression Analysis ◽

Glomerular Filtrate

Abstract Introduction In non-valvular atrial fibrillation (NVAF) patients, advanced age and chronic kidney disease (CKD) raise the thrombotic and bleeding rates, making the decision of antithrombotic therapy a challenge. Therefore, we conducted an analysis to explore the efficacy and safety of anticoagulation therapy in this population (AF patients ≥80 years) in comparison with younger AF patients (<80 years). Methods For these results we have analyzed data from FIBRA, a multicentric Spanish retrospective registry on patients with CKD-EPI <30 ml/min/1.73 m2 and newly diagnosed NVAF. For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event Results We analyzed 405 patients with CKD-EPI <30 ml/min/1.73 m2. 232 were ≥80 years-old (57.3%). Median of CHA2DS2-VASC and HASBLED scores were 5 and 3 in patients ≥80 years, respectively, and 3 and 2 in patients <80 years, respectively. The prescription of antithrombotic therapies in elderly versus younger patients is shown in Figure 1. During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). After multivariate analysis, no benefit of anticoagulation therapy was found for mortality in both, older and younger patients. In patients ≥80, anticoagulation was associated with higher rates of bleeding events without a decrease in embolic outcomes. Conclusion In our registry, anticoagulation has not shown benefit in NVAF patients ≥80 years with glomerular filtrate rate <30 ml/min/1.73 m2, increasing the risk of bleeding events without reducing embolic outcomes. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer alliance unconditional grant

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