Takeaway
- In patients aged ≥65 years with concomitant chronic kidney disease (CKD) and Afib, anticoagulants were associated with increased rates of ischaemic stroke and haemorrhage but lower all-cause mortality.
Why this matters
- There is a lack of high-quality guidelines and evidence on the optimal management of Afib and concomitant CKD not requiring dialysis.
- Risk for stroke and haemorrhage in these patients increases with declining renal function, which makes the decision to start anticoagulants difficult.
- The paradoxical findings in this study emphasise the urgent need for adequately powered randomised controlled trials to provide clarity on correct management.
Key results
- Of 6977 patients with CKD and newly diagnosed Afib, 2424 received anticoagulants within 60 days of diagnosis.
- Vitamin K antagonists were the most commonly used (71.7%), followed by rivaroxaban (12.7%), apixaban (10.8%), dabigatran (2.8%) unfractionated or low molecular weight heparin (1.8%), and edoxaban (0.17%).
- Over a median follow-up of 506 days, among the 4848 matched patients, there were 309 ischaemic strokes (6.4%), 79 gastrointestinal or cerebral haemorrhage (1.6%), and 1410 all-cause fatalities (29.1%). Crude rates for ischaemic stroke and haemorrhage were 4.6 and 1.2 per 100 person-years after anticoagulation, and 1.5 and 0.4 without anticoagulantion.
- HRs for stroke, haemorrhage and all-cause mortality were 2.60 (95% CI, 2.00-3.38), 2.42 (95% CI, 1.44-4.05) and 0.82 (95% CI, 0.74-0.91) with anticoagulations vs no anticoagulation.
Study design
- Propensity-matched, population-based, retrospective cohort analysis using the Royal College of General Practitioners Research and Surveillance Centre database of almost 2.73 million patients from 110 general practices across England and Wales.
- Funding: None.
Limitations
- Absence of data on the degree of renal impairment.
- Highly selected population.
References
References
