The Characteristics and Clinical Outcomes of Direct Oral Anticoagulantsin Patients with Atrial Fibrillation and Chronic Kidney Disease: From the Database of A Single-Center Registry.

Q3 Medicine
Journal of atrial fibrillation Pub Date : 2020-08-31 eCollection Date: 2020-08-01 DOI:10.4022/jafib.2308
Takao Sato, Yoshifusa Aizawa, Hitoshi Kitazawa, Masaaki Okabe
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引用次数: 2

Abstract

Background: This study aimed to evaluate the characteristics and clinical outcomes (major bleeding [MB] and thromboembolic events [TEEs]) of atrial fibrillation (AF) patients with chronic kidney disease (CKD)who receiveddirect oral anticoagulant (DOAC) therapy.

Methods: Data prospectivelycollected from a single-center registry containing 2,272 patients with DOAC prescription for AF (apixaban [n=1,014], edoxaban [n=267], rivaroxaban [n=498], and dabigatran[n=493]) were retrospectively analyzed. Patients were monitored for two years and classified into the CKD (n=1460) andnon-CKD groups(n=812). MB and TEEs were evaluated.

Results: The mean age was 72±10 years, with the CHADS2,CHA2DS2-VASc, and HAS-BLED scores being 1.95±1.32, 3.21±1.67, and 1.89±0.96,respectively.Incidence rates of MB and TEEs were 2.3%/year and 2.1%/year, respectively. The CKD groupwasolderand had lower body weight and higher CHADS2,CHA2DS2-VASc, and HAS-BLED scoresthanthe non-CKD group.Kaplan-Meier curve analysis revealed that the incidence of MB and TEEs was higher in the CKD group. Multiple logistic regression analysis in the CKD group revealed thatage andstroke history were independent determinants of TEEs, and low body weighttended to be a determinant of MB.The inappropriate low dose use was higher for apixaban than other DOACs in the CKD group. Consequently, for apixaban, the incidence of stroke was significantly higherin the CKD group than in the non-CKD group.

Conclusions: Patients with CKDwere characterized by factors that predisposed them to MB and TEEs, such as older age and low body weight. In a single-center registry, only treatment with apixaban in the CKD group led to a higher incidence of TEEs.

房颤合并慢性肾脏疾病患者直接口服抗凝剂的特点和临床结果:来自单中心注册数据库
背景:本研究旨在评估心房颤动(AF)合并慢性肾脏疾病(CKD)患者接受直接口服抗凝剂(DOAC)治疗的特点和临床结局(大出血[MB]和血栓栓塞事件[tee])。方法:前瞻性收集来自单中心登记的2272例使用DOAC处方治疗AF的患者的数据(阿哌沙班[n= 1014]、依多沙班[n=267]、利伐沙班[n=498]和达比加群[n=493])进行回顾性分析。患者监测2年,分为CKD组(n=1460)和非CKD组(n=812)。评估MB和tee。结果:患者平均年龄72±10岁,CHADS2、CHA2DS2-VASc、HAS-BLED评分分别为1.95±1.32、3.21±1.67、1.89±0.96。MB和tee的发病率分别为2.3%/年和2.1%/年。与非CKD组相比,CKD组年龄更大,体重更低,CHADS2、CHA2DS2-VASc和HAS-BLED评分更高。Kaplan-Meier曲线分析显示,CKD组MB和tee的发生率较高。CKD组的多因素logistic回归分析显示,年龄和卒中史是tee的独立决定因素,低体重倾向于是mb的决定因素。CKD组阿哌沙班的低剂量使用比其他doac更高。因此,对于阿哌沙班,CKD组的卒中发生率明显高于非CKD组。结论:ckd患者的特点是易患MB和tee的因素,如年龄大和体重低。在单中心登记中,仅在CKD组中使用阿哌沙班治疗会导致更高的tee发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of atrial fibrillation
Journal of atrial fibrillation Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.40
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