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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
- Authors
- Park H.; Yu H.T.; Kim T.-H.; Park J.; Park J.-K.; Kang K.-W.; Shim J.; Kim J.-B.; Kim J.; Choi E.-K.; Park H.W.; Lee Y.S.; Joung B.
- Ewha Authors
- 박준범
- SCOPUS Author ID
- 박준범
- Issue Date
- 2023
- Journal Title
- Yonsei Medical Journal
- ISSN
- 0513-5796
- Citation
- Yonsei Medical Journal vol. 64, no. 1, pp. 18 - 24
- Keywords
- Anticoagulant; atrial fibrillation; bleeding; dialysis; stroke
- Publisher
- Yonsei University College of Medicine
- Indexed
- SCIE; SCOPUS; KCI
- Document Type
- Article
- Abstract
- Purpose: Advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD) on dialysis, increases thromboem-bolic 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/m2) 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.
- DOI
- 10.3349/ymj.2022.0455
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
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