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Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registryopen access

Authors
Park, HanjinYu, Hee TaeKim, Tae-HoonPark, JunbeomPark, Jin-KyuKang, Ki-WoonShim, JaeminKim, Jin-BaeKim, JunChoi, Eue-KeunPark, Hyung WookLee, Young SooJoung, Boyoung
Issue Date
Jan-2023
Publisher
YONSEI UNIV COLL MEDICINE
Keywords
Anticoagulant; atrial fibrillation; bleeding; dialysis; stroke
Citation
YONSEI MEDICAL JOURNAL, v.64, no.1, pp.18 - 24
Indexed
SCIE
SCOPUS
KCI
Journal Title
YONSEI MEDICAL JOURNAL
Volume
64
Number
1
Start Page
18
End Page
24
URI
https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/185152
DOI
10.3349/ymj.2022.0455
ISSN
0513-5796
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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