Anticoagulation in patients with end-stage kidney disease and atrial fibrillation : a national population-based study
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA..
Background: The prevalence of atrial fibrillation (AF) in patients with end-stage kidney disease (ESKD) is high and increasing. However, evidence regarding oral anticoagulant (OAC) use in these patients is insufficient and conflicting.
Methods: This retrospective cohort study included patients in the Korea National Health Insurance System diagnosed with AF after ESKD onset from January 2007 to December 2017. The primary outcome was all-cause death. Secondary outcomes were ischaemic stroke, hospitalization for major bleeding and major adverse cardiovascular events (MACE). Outcomes were compared between OAC users and non-users using 6-month landmark analysis and 1:3 propensity score matching (PSM).
Results: Among patients with ESKD and AF, the number of prescribed OACs increased 2.3-fold from 2012 (n = 3579) to 2018 (n = 8341) and the proportion of direct OACs prescribed increased steadily from 0% in 2012 to 51.4% in 2018. After PSM, OAC users had a lower risk of all-cause death {hazard ratio [HR] 0.67 [95% confidence interval (CI) 0.55-0.81]}, ischaemic stroke [HR 0.61 (95% CI 0.41-0.89)] and MACE [HR 0.70 (95% CI 0.55-0.90)] and no increased risk of hospitalization for major bleeding [HR 0.99 (95% CI 0.72-1.35)] compared with non-users. Unlike warfarin, direct OACs were associated with a reduced risk of all-cause death and hospitalization for major bleeding.
Conclusions: In patients with ESKD and AF, OACs were associated with reduced all-cause death, ischaemic stroke and MACE.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
Clinical kidney journal - 17(2024), 2 vom: 12. Feb., Seite sfae029 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Deok-Gie [VerfasserIn] |
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| Links: |
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| Themen: |
Anticoagulation |
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| Anmerkungen: |
Date Revised 02.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1093/ckj/sfae029 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369155998 |
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| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. | ||
| 520 | |a Background: The prevalence of atrial fibrillation (AF) in patients with end-stage kidney disease (ESKD) is high and increasing. However, evidence regarding oral anticoagulant (OAC) use in these patients is insufficient and conflicting | ||
| 520 | |a Methods: This retrospective cohort study included patients in the Korea National Health Insurance System diagnosed with AF after ESKD onset from January 2007 to December 2017. The primary outcome was all-cause death. Secondary outcomes were ischaemic stroke, hospitalization for major bleeding and major adverse cardiovascular events (MACE). Outcomes were compared between OAC users and non-users using 6-month landmark analysis and 1:3 propensity score matching (PSM) | ||
| 520 | |a Results: Among patients with ESKD and AF, the number of prescribed OACs increased 2.3-fold from 2012 (n = 3579) to 2018 (n = 8341) and the proportion of direct OACs prescribed increased steadily from 0% in 2012 to 51.4% in 2018. After PSM, OAC users had a lower risk of all-cause death {hazard ratio [HR] 0.67 [95% confidence interval (CI) 0.55-0.81]}, ischaemic stroke [HR 0.61 (95% CI 0.41-0.89)] and MACE [HR 0.70 (95% CI 0.55-0.90)] and no increased risk of hospitalization for major bleeding [HR 0.99 (95% CI 0.72-1.35)] compared with non-users. Unlike warfarin, direct OACs were associated with a reduced risk of all-cause death and hospitalization for major bleeding | ||
| 520 | |a Conclusions: In patients with ESKD and AF, OACs were associated with reduced all-cause death, ischaemic stroke and MACE | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a anticoagulation | |
| 650 | 4 | |a atrial fibrillation | |
| 650 | 4 | |a bleeding | |
| 650 | 4 | |a death | |
| 650 | 4 | |a stroke | |
| 700 | 1 | |a Kim, Sung Hwa |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Sung Yong |e verfasserin |4 aut | |
| 700 | 1 | |a Han, Byoung Geun |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Jae Seok |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Jae Won |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Young Jun |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Jun Young |e verfasserin |4 aut | |
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