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Patients with atrial fibrillation and chronic kidney disease: non-vitamin K antagonist oral anticoagulants versus vitamin-K antagonists


The aim of study was to compare effectiveness and safety of non-vitamin K antagonist oral anticoagulants ( NOACs ) versus vitamin-K antagonists ( VKA ) in atrial fibrillation ( AF) patients with chronic kidney disease ( CKD ) not receiving dialysis.

Data from Danish administrative registries were analyzed. Researchers identified every citizen with a prior diagnosis of atrial fibrillation and chronic kidney disease who initiated NOAC or VKA ( 2011-2017 ).
An external analysis of 727 AF patients with chronic kidney disease ( no dialysis ) was performed to demonstrate level of kidney function in a comparable population.

Study outcomes included incidents of stroke / thromboembolisms, major bleedings, myocardial infarctions, and all-cause mortality.

Of 1560 patients included, 1008 ( 64.6% ) initiated vitamin-K antagonists and 552 ( 35.4% ) initiated NOAC.

In a comparable population researchers found that 95.3% of the patients had an estimated glomerular filtration rate ( eGFR ) less than 59 mL/min.

Patients treated with non-vitamin K antagonist oral anticoagulants had a significantly decreased risk of major bleeding ( hazard ratio, HR=0.47, 95% confidence interval ( CI ): 0.26-0.84 ) compared to vitamin-K antagonists.

There was not found a significant association between type of anticoagulant and risk of stroke / thromboembolisms ( HR=0.83, 95% CI: 0.39-1.78 ), myocardial infarction ( HR=0.45, 95% CI: 0.18-1.11 ), or all-cause mortality ( HR=0.99, 95% CI: 0.77-1.26 ).

In conclusion, non-vitamin K antagonist oral anticoagulant was associated with a lower risk of major bleeding in patients with atrial fibrillation and chronic kidney disease compared to vitamin-K antagonists.
No difference was found in risk of stroke / thromboembolisms, myocardial infarction, and all-cause mortality. ( Xagena )

Laugesen EK et al, Thromb J 2019;17:21. doi: 10.1186/s12959-019-0211-y. eCollection 2019

XagenaMedicine_2019



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