The Impacts of Oral Anticoagulants on Clinical Outcomes in Patients with Atrial Fibrillation Across Five Stages of Renal Function
medrxiv(2024)
摘要
Background To analyze the impact of using different renal function equations and stroke prevention strategy in atrial fibrillation (AF) across all chronic kidney disease (CKD) stages.
Methods We used the Cockcroft-Gault (CG), Modified Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to classify 39,217 patients into stage 1 to 5 CKD during July 1st, 2001, and September 30st, 2018. The endpoint is a composite outcome including ischemic stroke or major bleeding or mortality.
Results More patients belonged to stage 1 and 2 CKD using the MDRD and CKD-EPI equations. In subgroups of patients with eGFR-MDRD or eGFR-CKD-EPI ≥ 60 mL/min, a 17-18% increase of event was observed in patients with eGFR-CG < 60 mL/min compared to those ≥ 60 mL/min. Compared to no oral anticoagulant (OAC), OAC use was associated with a significantly lower risk of event across stage 1 to 4 CKD but not in stage 5 CKD. Both warfarin and NOACs exhibited better outcome compared to no OAC across stage 1 to 4 CKD while NOACs was associated with more risk reduction compared to warfarin. Among patients on OACs, there was a trend toward better outcome with NOAC than warfarin across stage 2-4 CKD but not in stage 1 and 5 CKD.
Conclusions OAC should be used in stage 1 to 4 CKD with NOAC exhibiting the trend of better outcome through stage 2 to 4 CKD than warfarin. For stage 5 CKD, optimal strategy remains undetermined.
Clinical Perspective
### Competing Interest Statement
The authors have declared no competing interest.
### Funding Statement
This study was supported by grants 105-2628-B-182A-003-MY3 from the Ministry of Science and Technology (MOST 110-2314-B-075-059, MOST 111-2314-B-075-004-MY2) and grants CMRPG3E1681, CMRPG3E1682, CMRPG3E1683, and CORPG3G0351 from Chang Gung Memorial Hospital, Linkou, Taiwan.
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
This study was approved by the Institutional Review Board of the Chang Gung Medical Foundation (201802075B0).
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The data underlying this article are available in the article.
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