Yonsei Med J.
2023 Jan;64(1):18-24. 10.3349/ymj.2022.0455.
Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
- Affiliations
-
- 1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 2Department of Cardiology, School of Medicine, Ewha Woman’s University, Seoul, Korea.
- 3Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea.
- 4Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
- 5Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
- 6Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
- 7Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 8Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
- 9Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea.
- 10Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
- KMID: 2537190
- DOI: http://doi.org/10.3349/ymj.2022.0455
Abstract
- Purpose
Advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD) on dialysis, increases thromboembolic risk among patients with atrial fibrillation (AF). This study examined the comparative safety and efficacy of direct-acting oral anticoagulant (DOAC) compared to warfarin or no oral anticoagulant (OAC) in AF patients with advanced CKD or ESRD on dialysis.
Materials and Methods
Using data from the COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry, 260 non-valvular AF patients with advanced CKD (defined as estimated glomerular filtration rate <30 mL/min per 1.73/m2 ) or ESRD on dialysis were enrolled from June 2016 to July 2020. The study population was categorized into DOAC, warfarin, and no OAC groups; and differences in major or clinically relevant non-major (CRNM) bleeding, stroke/systemic embolism (SE), myocardial infarction/critical limb ischemia (CLI), and death were assessed.
Results
During a median 24 months of follow-up, major or CRNM bleeding risk was significantly reduced in the DOAC group compared to the warfarin group [hazard ratio (HR) 0.11, 95% confidence interval (CI) 0.01 to 0.93, p=0.043]. In addition, the risk of composite adverse clinical outcomes (major or CRNM bleeding, stroke/SE, myocardial infarction/CLI, and death) was significantly reduced in the DOAC group compared to the no OAC group (HR 0.16, 95% CI 0.03 to 0.91, p=0.039).
Conclusion
Among AF patients with advanced CKD or ESRD on dialysis, DOAC was associated with a lower risk of major or CRNM bleeding compared to warfarin and a lower risk of composite adverse clinical outcomes compared to no OAC. ClinicalTrials.gov (NCT02786095)
Keyword
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Stroke Prevention in Atrial Fibrillation
- Anticoagulation in Atrial Fibrillation
- Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences
- 2021 Korean Heart Rhythm Society Guidelines for Screening and Management of Subclinical Atrial Fibrillation
- Occurrence of Ischemic Stroke in Patients With Atrial Fibrillation Receiving Non-Vitamin K Oral Anticoagulants: Causes and Prevention Strategies
