Int J Arrhythm.  2020 Mar;21(1):e3. 10.1186/s42444-020-0011-2.

Differences in anticoagulation strategy and outcome in atrial fibrillation patients with chronic kidney disease: a CODE‑AF registry study

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Severance Car‑ diovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 2Department of Internal Medicine, Seoul National University Hospi‑ tal, Seoul, Republic of Korea
  • 3Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Repub‑ lic of Korea
  • 4Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
  • 5Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Republic of Korea
  • 6Division of Cardiology, Eulji University Hospital, Daejeon, Republic of Korea
  • 7Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
  • 8Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  • 9Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
  • 10Department of Preventive Medi‑ cine, Institute of Human Complexity and Systems Science, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 11Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea

Abstract

Purpose
Dose reduction of non-vitamin K antagonist oral anticoagulants (NOACs) is indicated in patients with atrial fibrillation (AF) with renal impairment. This study investigated anticoagulation patterns and outcomes in patients with chronic kidney disease (CKD).
Materials and methods
In a prospective observational registry (CODE-AF), 3445 patients with non-valvular AF including 1129 with CKD (estimated glomerular filtration rate ≤ 60 mL min−1 1.73 m−2) were identified between June 1, 2016, and July 3, 2017.
Results
Compared with patients with no-CKD, patients with CKD more frequently had a high stroke risk (94.9% vs. 67.0%, p < 0.001) and higher NOAC usage rate (61.1% vs. 47.8%, p < 0.001). Among 718 patients with renal indication for dose reduction (RIDR), 7.5% were potentially overdosed. Among 2587 patients with no-RIDR, 79% were potentially underdosed. Compared with patients with no-RIDR, the underdose rates of dabigatran (0% vs. 88.6%, p = 0.001) and rivaroxaban (0% vs. 79.5%, p = 0.001) were lower in patients with RIDR. However, the underdose rate of apixaban was not different (62.5% vs. 53.9%, p = 0.089). The overdose rate of dabigatran (7.5% vs. 0%) and rivaroxaban (13.7% vs. 0%) was higher in RIDR than in no-RIDR patients. Stroke/transient ischemic attack was significantly higher in CKD patients (1.4 vs. 0.6 per 100 person-years, p = 0.045). Aspirin significantly increased minor bleeding in CKD patients compared with controls (p = 0.037).
Conclusion
CKD patients might have a high stroke risk and NOAC usage rate. The underdose rate of NOACs decreased in CKD patients, except for apixaban. Aspirin significantly increased minor bleeding in CKD patients.

Keyword

Atrial fibrillation; Anticoagulation; Kidney diseases; Stroke
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