Risk of Bleeding, Thrombosis and Death among Atrial Fibrillation Patients Treated with Oral Anticoagulants Across Estimated Glomerular Filtration Rates

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2024-12-02 DOI:10.1016/j.amjcard.2024.11.033

Xinhai Huang MD , Donglin Xie MD , Jie Huang MD , Ruijuan Li MD , Qiaowei Zheng MD , Xiumei Liu MD , Hengfen Dai MD , Xiangsheng Lin BS , Yuxin Liu MD , Jun Su MD , Xiaomin Dong MD , Yanxian Lan MD , Cuifang You MD , Shuzheng Jiang MD , Jinhua Zhang PhD

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引用次数: 0

Abstract

There are limited data about the clinical benefits and harm of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) and chronic kidney disease using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation for glomerular filtration rate (GFR) estimation in nuanced GFR stratification. We conducted a retrospective study in 12 centers in China and included 9,510 patients with AF. We grouped patients into the following estimated GFR (eGFR) categories: ≥60 (n = 7,616), 45 to 59 (n = 1,139), 30 to 44 (n = 474), and <30 (n = 281) ml/min/1.73 m². Logistic regression was used to the compare risks of major bleeding, minor bleeding, total bleeding, thrombosis, and all-cause deaths in patients with AF with eGFR 45 to 59, 30 to 44, <30 ml/min/1.73 m², and ≥60 ml/min/1.73 m² after taking OACs. Patients with AF treated with OACs with eGFR 45 to 59, 30 to 44, and <30 ml/min/1.73 m² had a significantly increased risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m² (adjusted odds ratio [aOR] 1.326, 95% confidence interval [CI] 1.049 to 1.665, p = 0.016; aOR 1.634, 95% CI 1.197 to 2.200, p = 0.002; aOR 2.492, 95% CI 1.766 to 3.471, p <0.001; respectively). Higher eGFR was associated with a significantly lower risk of all-cause deaths (aOR 0.990, 95% CI 0.986 to 0.994, p <0.001) and major bleeding (aOR 0.988, 95% CI 0.979 to 0.998, p = 0.018). Direct OACs remarkably reduced risk of major bleeding in those with eGFR 30 to 44 ml/min/1.73 m² compared with warfarin. In conclusion, in patients with AF treated with OACs, patients with eGFR 45 to 59, 30 to 44, and <30 ml/min/1.73 m² had a significantly increased risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m², and the risk of all-cause deaths increased with decreasing eGFR. Direct OACs are at least safe alternatives to warfarin in patients with AF with eGFR 30 to 44 ml/min/1.73 m².

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口服抗凝剂治疗房颤患者的出血、血栓和死亡风险与肾小球滤过率的关系

在精细的肾小球滤过率（GFR）分层中，使用CKD- epi肌酐方程估算肾小球滤过率（GFR），关于口服抗凝剂（OACs）预防房颤（AF）和慢性肾脏疾病（CKD）患者卒中的临床获益和危害的数据有限。我们在中国12个中心进行了回顾性研究，纳入9510例房颤患者。我们将患者分为以下eGFR类别：≥60(n=7616), 45-59(n=1139), 30-44（n=474）和2。采用Logistic回归比较服用OACs后eGFR 45-59、30-44、2和≥60 mL/min/1.73 m2的AF患者大出血、小出血、全出血、血栓形成和全因死亡的风险。与eGFR≥60 ml/min/1.73 m2的oac相比，eGFR为45-59、30-44和2的AF患者全因死亡风险显著升高(aOR: 1.326, 95% CI: 1.049-1.665， P=0.016；aOR: 1.634, 95% CI: 1.197 ~ 2.200， P=0.002；aOR: 2.492, 95% CI: 1.766 ~ 3.471，与华法林比较为P2。综上所示，在接受OACs治疗的AF患者中，eGFR为45-59、30-44和2的患者与eGFR≥60 ml/min/1.73 m2的患者相比，全因死亡风险显著升高，且全因死亡风险随eGFR的降低而增加。对于eGFR为30-44ml/min/ 1.73 m2的AF患者，doac至少是华法林的安全替代品。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.