Influence of renal function on anticoagulation control in patients with non-valvular atrial fibrillation taking vitamin K antagonists

Lobos-Bejarano, José María; Rodríguez, Alonso Mateos; Barrios, Vivencio; Escobar, Carlos; Polo-García, José; Castillo-Rodríguez, José Carlos del; Vargas-Ortega, Diego; López-Pineda, Adriana; Valiente, Luis; Lip, Gregory Y.H.; Team, Paula Study

doi:10.1111/ijcp.12974

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…The study by Szummer et al [17] found that low TTR caused an increased risk of the composite outcome of ischaemic stroke, myocardial infarction, intracranial haemorrhage and mortality; however, the mean TTR was exceptionally high (83%) in this observational study. Other studies have similarly demonstrated that good anticoagulation control was independently associated with lower risk of stroke, mortality, and major bleeding [14, 16, 18]. Nonetheless, Bonde et al [18] found that this effect was only observed in patients with an eGFR between 30 and 60 mL/min/1.73 m 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Two studies have shown that even moderate CKD was associated with lower TTR [15, 16]. In addition, traditional predictive factors of reduced TTR were not useful in patients with CKD [16].…”

Section: Discussionmentioning

confidence: 99%

“…Two studies have shown that even moderate CKD was associated with lower TTR [15, 16]. In addition, traditional predictive factors of reduced TTR were not useful in patients with CKD [16]. In contrast, Esteve-Pastor et al [19] found that TTR was only affected in patients with AF who had severe CKD (eGFR <30 mL/min/1.73 m 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation: A post hoc Analysis from the AMADEUS Trial

2021

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Background: The benefit of anticoagulation therapy in atrial fibrillation (AF) and chronic kidney disease (CKD) remains controversial. We aimed to evaluate the impact of renal function on the quality of anticoagulation control, and the effects of both these factors on outcomes in AF. Methods: Post hoc analysis of the AMADEUS trial. Trial-related outcomes were adjudicated and we studied the composite of first stroke/major bleeding/all-cause mortality, ischaemic stroke, major bleeding, all-cause mortality, and cardiovascular mortality. Results: We included 2,282 vitamin K antagonist (VKA)-treated patients {n = 787 (34.5%) females; median age 72 (interquartile ranges [IQR] 64–77) years}. Median follow-up was 365 (IQR 189–460) days. There were 1,922 (84.2%) non-CKD and 360 (15.8%) CKD patients. Renal function was inversely correlated with time-in-therapeutic range (r = −0.047, p = 0.025). There was no statistical difference in terms of crude study outcomes based on renal function. Multivariable regression analysis demonstrated that moderate renal failure with estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 (p = 0.032) and percentage of time-in-therapeutic range (p = 0.011) were independent predictors for the composite outcome of stroke, major bleeding, and all-cause mortality. Conclusion: Deteriorated renal function has a small negative impact on the quality of anticoagulation control with VKA which is linked to poor outcomes in AF. However, moderate renal failure itself was an independent risk factor for increased risk of stroke, major bleeding, and all-cause mortality amongst patients with AF.

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Section: Discussionmentioning

confidence: 99%

“…Two studies have shown that even moderate CKD was associated with lower TTR [15, 16]. In addition, traditional predictive factors of reduced TTR were not useful in patients with CKD [16].…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation: A post hoc Analysis from the AMADEUS Trial

2021

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“…ROC curves are widely used in the performance evaluation of medical diagnostic tests, which can obtain multiple pairs of true positive rates (TPR) and false positive rates (FPR) by changing the diagnostic boundary. The curve is drawn with FPR as the abscissa, and with TPR as the ordinate (19,20). The diagnostic value of the diagnostic test is reflected by calculating and comparing the AUC.…”

Section: Discussionmentioning

confidence: 99%

A predictive study of multivariate factors affecting goal attainment of INR after anticoagulation in patients with nonvalvular atrial fibrillation

Chang¹,

Pan²,

Wang³

et al. 2021

Ann Palliat Med

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Background: Non-valvular atrial fibrillation (NVAF) is a common type of AF, and patients with NVAF have a higher risk of ischemic stroke than non-AF patients. This study aims to investigate the goal attainment of international normalized ratio (INR) in patients with NVAF after anticoagulation therapy, and to analyze the risk factors that affect the goal attainment of INR. Methods: NVAF patients who were admitted to our hospital from December 2019 to December 2020 and received anticoagulation therapy were selected as the research subjects. The INR goal attainment of patients was assessed, the risk factors affecting INR goal attainment were analyzed, and a ROC curve was drawn to evaluate the predictive value of risk factors for INR goal attainment in NVAF patients. Results: After anticoagulation treatment, the INR of 42 cases reached the target (INR value ≥0.2, the goal attainment group), and the INR of 74 cases did not reach the target (INR value <2.0, the non-goal attainment group). The age, mean platelet volume (MPV), platelet distribution width (PDW), and largeplatelet ratio (P-LCR) levels of patients in the goal attainment group were significantly lower than those in the non-goal attainment group, and the platelet count (PLT) level was higher than that of the non-goal attainment group (P<0.05). The results of multivariate logistic regression analysis showed that MPV, PDW, and P-LCR were independent risk factors that affected the failure in INR goal attainment in patients with NVAF after anticoagulation therapy. The ROC curve showed that the AUC values of MPV, PDW, and P-LCR were 0.711, 0.748, 0.867, respectively, and the combined AUC was 0.876, which was higher than that of the single detection.Conclusions: MPV, PDW, and P-LCR are important factors that affect the goal attainment of INR after anticoagulant therapy in NVAF patients. For patients with risk factors, clinicians can formulate a reasonable individualized anticoagulant drug regimen based on the above-mentioned index levels.

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“…Lobos‐Bejarano et al () found that the TTR decreased with declining renal function, with only 42% of those with an estimated glomerular filtration rate (eGFR) ≤29 ml/min per 1·73 m 2 meeting the TTR ≥ 65%, with an increase in the variability of INRs. A study of patients in Sweden with AF discharged on warfarin after myocardial infarction (MI) found that warfarin reduced the risk of a composite of death, MI and ischaemic stroke without increasing bleeding risk in those patients with an eGFR < 15 ml/min per 1·73 m 2 (Carrero et al , ).…”

Section: Time In Therapeutic Range and Esrdmentioning

confidence: 99%

Is anticoagulating haemodialysis patients with non‐valvular atrial fibrillation too risky?

Parker

Mitra²,

Thachil

2018

Br J Haematol

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There is an increasing understanding of the risks from atrial fibrillation (AF) in the current era. In patients with end-stage renal disease (ESRD) on dialysis, the prevalence of AF is significantly higher compared to the general population and those with earlier stages of CKD. Although anticoagulation of these patients may seem appropriate, there is a lack of conclusive evidence that it provides the same protection from thromboembolic complications as it does in patients not on dialysis. In addition, the increased risk of bleeding in patients requiring dialysis makes the use of anticoagulants less favourable. This article aims to discuss the problem of AF in dialysis patients, summarise the current evidence around the use of oral anticoagulants for AF in ESRD and provide some practical suggestions on management of AF in the haemodialysis population.

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Influence of renal function on anticoagulation control in patients with non-valvular atrial fibrillation taking vitamin K antagonists

Cited by 6 publications

References 31 publications

Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation: A post hoc Analysis from the AMADEUS Trial

Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation: A post hoc Analysis from the AMADEUS Trial

A predictive study of multivariate factors affecting goal attainment of INR after anticoagulation in patients with nonvalvular atrial fibrillation

Is anticoagulating haemodialysis patients with non‐valvular atrial fibrillation too risky?

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