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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Yonsei University College of Medicine
2023
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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) |
format | Online Article Text |
id | pubmed-9826956 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Yonsei University College of Medicine |
record_format | MEDLINE/PubMed |
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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