Are Anticoagulants Safe for Patients With Concomitant AF, CKD?
Anticoagulant therapy is associated with increased rates of ischemic stroke and hemorrhage but lower rates of mortality in older patients with atrial fibrillation (AF) and chronic kidney disease (CKD), according to a new study.
For their study, the researchers assessed 6977 patients aged 65 years or older with a new diagnosis of AF and estimated glomerular filtration rate (eGFR) of less than 50 mL/min/1.73m2. Of these patients, 2434 were taking anticoagulants within 60 days of diagnosis, and the remaining 4543 were not.
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A total of 2424 propensity pairs were matched, and median follow-up lasted 506 days. Patient data from January 2006 through December 2016 were obtained from the Royal College of General Practitioners Research and Surveillance Centre database.
For ischemic stroke, crude rates were 4.6 per 100,000 person years for patients taking anticoagulants and 1.5 per 100,000 person years for patients taking no anticoagulants. For hemorrhage, crude rates were 1.2 and 0.4 per 100,000 person years for patients taking and not taking anticoagulants, respectively.
For anticoagulant-treated patients, hazard ratios were 2.60 for ischemic stroke, 2.42 for hemorrhage, and 0.82 for all-cause mortality compared with those who were not treated with anticoagulants.
“Giving anticoagulants to older people with concomitant atrial fibrillation and chronic kidney disease was associated with an increased rate of ischemic stroke and hemorrhage but a paradoxical lowered rate of all-cause mortality,” the researchers concluded. “Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation. “
—Christina Vogt
Reference:
Kumar S, de Lusignan S, McGovern A, et al. Ischemic stroke, hamorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care [Published online February 14, 2018]. BMJ. https://doi.org/10.1136/bmj.k342.