Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease
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 (CK...
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.751359/full |
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| author | Kuo-Hua Lee Kuo-Hua Lee Kuo-Hua Lee Kuo-Hua Lee Shuo-Ming Ou Shuo-Ming Ou Shuo-Ming Ou Shuo-Ming Ou Yuan-Chia Chu Yuan-Chia Chu Yao-Ping Lin Yao-Ping Lin Yao-Ping Lin Yao-Ping Lin Ming-Tsun Tsai Ming-Tsun Tsai Ming-Tsun Tsai Ming-Tsun Tsai Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng |
| author_facet | Kuo-Hua Lee Kuo-Hua Lee Kuo-Hua Lee Kuo-Hua Lee Shuo-Ming Ou Shuo-Ming Ou Shuo-Ming Ou Shuo-Ming Ou Yuan-Chia Chu Yuan-Chia Chu Yao-Ping Lin Yao-Ping Lin Yao-Ping Lin Yao-Ping Lin Ming-Tsun Tsai Ming-Tsun Tsai Ming-Tsun Tsai Ming-Tsun Tsai Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng |
| author_sort | Kuo-Hua Lee |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T04:01:05Z |
| format | Article |
| id | doaj.art-81eb558eefff42078141952ddd213ac1 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-20T04:01:05Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-81eb558eefff42078141952ddd213ac12022-12-21T19:54:10ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-10-01810.3389/fcvm.2021.751359751359Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery DiseaseKuo-Hua Lee0Kuo-Hua Lee1Kuo-Hua Lee2Kuo-Hua Lee3Shuo-Ming Ou4Shuo-Ming Ou5Shuo-Ming Ou6Shuo-Ming Ou7Yuan-Chia Chu8Yuan-Chia Chu9Yao-Ping Lin10Yao-Ping Lin11Yao-Ping Lin12Yao-Ping Lin13Ming-Tsun Tsai14Ming-Tsun Tsai15Ming-Tsun Tsai16Ming-Tsun Tsai17Der-Cherng Tarng18Der-Cherng Tarng19Der-Cherng Tarng20Der-Cherng Tarng21Der-Cherng Tarng22Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanInformation Management Office, Taipei Veterans General Hospital, Taipei City, TaiwanBig Data Center, Taipei Veterans General Hospital, Taipei City, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDepartment and Institute of Physiology, National Yang-Ming University, Taipei City, TaiwanBackground: 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.https://www.frontiersin.org/articles/10.3389/fcvm.2021.751359/fullanticoagulationacute myocardial infarctionatrial fibrillationstrokethromboembolism |
| spellingShingle | Kuo-Hua Lee Kuo-Hua Lee Kuo-Hua Lee Kuo-Hua Lee Shuo-Ming Ou Shuo-Ming Ou Shuo-Ming Ou Shuo-Ming Ou Yuan-Chia Chu Yuan-Chia Chu Yao-Ping Lin Yao-Ping Lin Yao-Ping Lin Yao-Ping Lin Ming-Tsun Tsai Ming-Tsun Tsai Ming-Tsun Tsai Ming-Tsun Tsai Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease Frontiers in Cardiovascular Medicine anticoagulation acute myocardial infarction atrial fibrillation stroke thromboembolism |
| title | Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease |
| title_full | Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease |
| title_fullStr | Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease |
| title_full_unstemmed | Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease |
| title_short | Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease |
| title_sort | antithrombotic therapy for chronic kidney disease patients with concomitant atrial fibrillation and coronary artery disease |
| topic | anticoagulation acute myocardial infarction atrial fibrillation stroke thromboembolism |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.751359/full |
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