肾功能对老年体弱非瓣膜性房颤合并慢性肾病患者口服抗凝治疗安全性和有效性的影响。

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology Pub Date : 2025-06-14 DOI:10.1159/000546865

Mohammed A Qutub, Alaa S Algazzar, Abdullah K Alassiri, Saud A Albukhari, Abdallah H Bokhary, Alsayed Ali Almarghany, Ahmed AbdElmoez Elsayed, Mohamed M Elbably

{"title":"肾功能对老年体弱非瓣膜性房颤合并慢性肾病患者口服抗凝治疗安全性和有效性的影响。","authors":"Mohammed A Qutub, Alaa S Algazzar, Abdullah K Alassiri, Saud A Albukhari, Abdallah H Bokhary, Alsayed Ali Almarghany, Ahmed AbdElmoez Elsayed, Mohamed M Elbably","doi":"10.1159/000546865","DOIUrl":null,"url":null,"abstract":"Background: The effectiveness and safety of oral anticoagulants (OAC) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in Frail Elderly patients has not been fully established.Objectives: To determine the safety and effectiveness related to OACs in Frail Elderly patients with AF and CKD stage II and III.Methods: Frail Elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial bleeding (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding.Results: The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was non-significant, (2.6±1.01 vs 2.8±0.89, p value 0.054), for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. HAS-BLED score (1.9±0.67 vs 2.3±0.70, p value 0.071) for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73m², Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73m² vs. 8.7% in GFR <60 mL/min/1.73m² (HR 1.02, 95% CI 0.60-1.74, p=0.24). Composite ICH/GI bleeding occurred in 7.1% vs. 9.3% (HR 0.89, 95% CI 0.45-2.72, p=0.41).Conclusion: In this study comparing Frail Elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed No significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well-managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-19"},"PeriodicalIF":1.9000,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Influence of Renal Function on Safety and Effectiveness of Oral Anticoagulant Treatment Among Frail Elderly Patients with Non- Valvular Atrial Fibrillation and Chronic Kidney Disease.\",\"authors\":\"Mohammed A Qutub, Alaa S Algazzar, Abdullah K Alassiri, Saud A Albukhari, Abdallah H Bokhary, Alsayed Ali Almarghany, Ahmed AbdElmoez Elsayed, Mohamed M Elbably\",\"doi\":\"10.1159/000546865\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: The effectiveness and safety of oral anticoagulants (OAC) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in Frail Elderly patients has not been fully established.Objectives: To determine the safety and effectiveness related to OACs in Frail Elderly patients with AF and CKD stage II and III.Methods: Frail Elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial bleeding (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding.Results: The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was non-significant, (2.6±1.01 vs 2.8±0.89, p value 0.054), for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. HAS-BLED score (1.9±0.67 vs 2.3±0.70, p value 0.071) for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73m², Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73m² vs. 8.7% in GFR <60 mL/min/1.73m² (HR 1.02, 95% CI 0.60-1.74, p=0.24). Composite ICH/GI bleeding occurred in 7.1% vs. 9.3% (HR 0.89, 95% CI 0.45-2.72, p=0.41).Conclusion: In this study comparing Frail Elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed No significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well-managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.\",\"PeriodicalId\":9391,\"journal\":{\"name\":\"Cardiology\",\"volume\":\" \",\"pages\":\"1-19\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-06-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000546865\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000546865","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

背景：口服抗凝剂（OAC）在老年体弱患者慢性肾病（CKD）和非瓣膜性心房颤动（NVAF）患者中的有效性和安全性尚未完全确定。目的：探讨OACs治疗老年AF合并CKD II期和III期患者的安全性和有效性。方法：回顾性分析2022年1月至2024年6月期间接受OAC治疗的≥65岁房颤和CKD体弱老年患者。主要终点是缺血性卒中和全身性栓塞（IS/SE）的复合，以及颅内出血（ICH）和/或胃肠道出血（GI）的复合。次要终点包括任何出血。结果：该研究纳入365例患者，其中141例（38.6%）开始华法林治疗，224例（61.3%）开始DOACs治疗。GFR≥60和GFR < 60 mL/min/1.73m²患者的CHA2DS2-VASc评分无统计学意义（2.6±1.01 vs 2.8±0.89，p值0.054）。GFR≥60和GFR < 60 mL/min/1.73m²患者的ha - bled评分分别为1.9±0.67 vs 2.3±0.70，p值为0.071。结论：在这项研究中，我们比较了虚弱的老年NVAF和CKD II期患者与接受OACs的III期患者，我们观察到两组之间IS/SE或ICH/GI出血的风险无显著差异。这些发现表明，在中度CKD （eGFR 30-89 mL/min）中，当抗凝管理良好时，肾功能分期可能不会独立影响oac相关结果。我们的结果可能不适用于体质较弱的人群或晚期CKD患者。需要进一步的更大样本量的前瞻性研究，为在这种具有挑战性的临床情况下最佳使用OACs提供更清晰的指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

The Influence of Renal Function on Safety and Effectiveness of Oral Anticoagulant Treatment Among Frail Elderly Patients with Non- Valvular Atrial Fibrillation and Chronic Kidney Disease.

Background: The effectiveness and safety of oral anticoagulants (OAC) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in Frail Elderly patients has not been fully established.

Objectives: To determine the safety and effectiveness related to OACs in Frail Elderly patients with AF and CKD stage II and III.

Methods: Frail Elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial bleeding (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding.

Results: The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was non-significant, (2.6±1.01 vs 2.8±0.89, p value 0.054), for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. HAS-BLED score (1.9±0.67 vs 2.3±0.70, p value 0.071) for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73m², Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73m² vs. 8.7% in GFR <60 mL/min/1.73m² (HR 1.02, 95% CI 0.60-1.74, p=0.24). Composite ICH/GI bleeding occurred in 7.1% vs. 9.3% (HR 0.89, 95% CI 0.45-2.72, p=0.41).

Conclusion: In this study comparing Frail Elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed No significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well-managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Cardiology 医学-心血管系统

CiteScore

3.40

自引率

5.30%

发文量

审稿时长

1.5 months

期刊介绍： ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.