Novel anticoagulants for stroke prevention in atrial fibrillation and chronic kidney disease

Turagam, Mohit K.; Addepally, Naga Saranya; Velagapudi, Poonam

doi:10.1586/14779072.2013.839188

Cited by 3 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To the best of our knowledge, this is the first study to show that OAC alone significantly reduced the CV risks and resulted in lower bleeding and mortality risks compared with combination therapy among patients with CKD and concomitant AF and CAD. Antiplatelets have been considered the drug of choice on primary and secondary preventions in patients with CAD and CKD (6), whereas OAC therapy is crucial for lowering the risk for stroke and thromboembolism in patients with concomitant AF and CKD (7). Our finding has clinical relevance since some physicians prefer prescribing antiplatelets instead of OACs for CKD patients at high bleeding risk.…”

Section: Discussionmentioning

confidence: 70%

Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease

Lee

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Oral anticoagulants (OAC) plus antiplatelets is recommended for patients with atrial fibrillation (AF) and coronary artery disease (CAD) to reduce thromboembolism. However, there is limited evidence regarding antithrombotic therapy for patients with concomitant chronic kidney disease (CKD), AF, and CAD, especially those not undergoing percutaneous coronary intervention. We aimed to use real-world data assessing the efficacy and safety of antithrombotic regimens in this population.Methods: We used a single-center database of 142,624 CKD patients to identify those receiving antithrombotic therapy for AF and CAD between 2010 and 2018. Patients taking warfarin or direct OAC (DOAC) alone were grouped in the OAC monotherapy (n = 537), whereas those taking OAC plus antiplatelets were grouped in the combination therapy (n = 2,391). We conducted propensity score matching to balance baseline covariates. The endpoints were all-cause mortality, major adverse cardiovascular events, and major bleedings.Results: After 1:4 matching, the number of patients in OAC monotherapy and combination therapy were 413 and 1,652, respectively. Between the two groups, combination therapy was associated with higher risks for ischemic stroke (HR 2.37, CI 1.72–3.27), acute myocardial infarction (HR 6.14, CI 2.51–15.0), and hemorrhagic stroke (HR 3.57, CI 1.35–9.81). The results were consistent across CKD stages. In monotherapy, DOAC users were associated with lower risks for all-cause mortality, AMI, and gastrointestinal bleeding than warfarin, but the stroke risk was similar between the two subgroups.Conclusions: For patients with concomitant CKD, AF and CAD not undergoing PCI, OAC monotherapy may reduce stroke and AMI risks. DOAC showed more favorable outcomes than warfarin.

show abstract

Section: Discussionmentioning

confidence: 70%

Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease

Lee

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…11 At present, it is recommended that anticoagulation is beneficial in patients with AF and mild-moderate CKD. 12 In those with severe CKD, warfarin may still be beneficial, providing that very meticulous attention to TTR is given and a TTR > 70% is maintained. NOACs should be used with caution in patients with CKD, given the lack of trial outcome data in those with creatinine clearance < 25 to 30 mL/min.…”

mentioning

confidence: 99%

Treatment of Atrial Fibrillation in Patients With Chronic Kidney Disease

Shahid

Shantsila

Lip

2016

Chest

View full text Add to dashboard Cite

“…5 Indications for these new agents are expected to expand as new clinical trial results become available. 6,7 This review summarizes the clinically relevant characteristics of the new oral anticoagulants (Table 1) and provides guidance on their usage (Table 2).…”

mentioning

confidence: 99%

The new oral anticoagulants: Reasonable alternatives to warfarin

Roca

2015

CCJM

View full text Add to dashboard Cite

Dabigatran (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (direct activated factor X inhibitors) are increasingly being used in clinical practice. Compared with vitamin K antagonists, they are more convenient, do not require laboratory monitoring, have limited drug and food interactions, and have fixed dosages suitable for most patients. But the shortcomings of these agents can jeopardize their efficacy and increase the risk of bleeding. Their future role in preventing and treating thromboembolic disease will depend on building clinical experience, but current evidence indicates that they are reasonable alternatives to vitamin K antagonists.

show abstract

Novel anticoagulants for stroke prevention in atrial fibrillation and chronic kidney disease

Cited by 3 publications

References 13 publications

Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease

Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease

Treatment of Atrial Fibrillation in Patients With Chronic Kidney Disease

The new oral anticoagulants: Reasonable alternatives to warfarin

Contact Info

Product

Resources

About