Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registryopen access
- Authors
- Park, Hanjin; Yu, Hee Tae; Kim, Tae-Hoon; Park, Junbeom; Park, Jin-Kyu; Kang, Ki-Woon; Shim, Jaemin; Kim, Jin-Bae; Kim, Jun; Choi, Eue-Keun; Park, Hyung Wook; Lee, Young Soo; Joung, Boyoung
- Issue Date
- Jan-2023
- Publisher
- YONSEI UNIV COLL MEDICINE
- Keywords
- Anticoagulant; atrial fibrillation; dialysis; stroke; bleeding
- Citation
- YONSEI MEDICAL JOURNAL, v.64, no.1, pp 18 - 24
- Pages
- 7
- Journal Title
- YONSEI MEDICAL JOURNAL
- Volume
- 64
- Number
- 1
- Start Page
- 18
- End Page
- 24
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/72428
- DOI
- 10.3349/ymj.2022.0455
- ISSN
- 0513-5796
1976-2437
- 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/m(2)) 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.
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