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

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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Yonsei University College of Medicine 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826956/
https://www.ncbi.nlm.nih.gov/pubmed/36579375
http://dx.doi.org/10.3349/ymj.2022.0455
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author 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
author_facet 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
author_sort Park, Hanjin
collection PubMed
description 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. ClinicalTrials.gov (NCT02786095)
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spelling pubmed-98269562023-01-20 Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry 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 Yonsei Med J Original Article 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. ClinicalTrials.gov (NCT02786095) Yonsei University College of Medicine 2023-01 2022-12-16 /pmc/articles/PMC9826956/ /pubmed/36579375 http://dx.doi.org/10.3349/ymj.2022.0455 Text en © Copyright: Yonsei University College of Medicine 2023 https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
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
Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
title Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
title_full Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
title_fullStr Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
title_full_unstemmed Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
title_short Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Advanced Chronic Kidney Disease: CODE-AF Registry
title_sort oral anticoagulation therapy in atrial fibrillation patients with advanced chronic kidney disease: code-af registry
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826956/
https://www.ncbi.nlm.nih.gov/pubmed/36579375
http://dx.doi.org/10.3349/ymj.2022.0455
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