Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF
Objective Anticoagulation management in patients with atrial fibrillation (AF) and impaired renal function is challenging. This study aimed to evaluate anticoagulation prescription patterns in relation to renal function and to describe 2-year clinical outcomes among dabigatran users. Meth...
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2021-01-01
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| Series: | TH Open |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1722706 |
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| author | Sake J. van der Wall Christine Teutsch Sergio J. Dubner Hans-Christoph Diener Jonathan L. Halperin Chang Sheng Ma Kenneth J. Rothman Miney Paquette Kristina Zint Lionel Riou França Shihai Lu Gregory Y. H. Lip Menno V. Huisman |
| author_facet | Sake J. van der Wall Christine Teutsch Sergio J. Dubner Hans-Christoph Diener Jonathan L. Halperin Chang Sheng Ma Kenneth J. Rothman Miney Paquette Kristina Zint Lionel Riou França Shihai Lu Gregory Y. H. Lip Menno V. Huisman |
| author_sort | Sake J. van der Wall |
| collection | DOAJ |
| description | Objective Anticoagulation management in patients with atrial fibrillation (AF) and impaired renal function is challenging. This study aimed to evaluate anticoagulation prescription patterns in relation to renal function and to describe 2-year clinical outcomes among dabigatran users.
Methods Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international, prospective, and observational study program involving patients with newly diagnosed AF at risk for stroke. Prescription patterns were assessed by creatinine clearance (CrCl) at enrollment. Dabigatran users were followed for 2 years. Clinical outcomes were standardized for stroke and bleeding risk, based on CHA2DS2-VASc and HAS-BLED scores, with missing values imputed.
Results Baseline CrCl values were available for 12,056 of 15,308 eligible patients (79%). With declining renal function, prescriptions increased for vitamin K antagonists (VKAs) and decreased for dabigatran (30–47% and 34–12%, respectively). The prescription of other non-vitamin K antagonists remained similar across CrCl groups (14–19%). In 4,873 dabigatran users, standardized stroke rates were low across all CrCl groups; 0.58/100 patient-years (95% confidence interval [CI]: 0.30–0.90) in CrCl ≥80 mL/min, 0.85 (95% CI: 0.48–1.21) in CrCl 50 to 79 mL/min, and 0.33 (95% CI: 0.06–1.11) in CrCl 30 to 49 mL/min. Similarly, major bleeding rates were low and numerically increased with declining renal function (0.68/100 patient-years, 95% CI: 0.39–1.03; 0.92, 95% CI: 0.58–1.32; and 1.26, 95% CI: 0.66–1.97, respectively).
Conclusion In patients with AF, VKA prescriptions increased and dabigatran prescriptions decreased with declining renal function. Rates of stroke and major bleeding in dabigatran patients remained low across the categories of renal impairment. |
| first_indexed | 2024-12-24T05:31:14Z |
| format | Article |
| id | doaj.art-fe4f963d8c3145c5988f99f3efdf9830 |
| institution | Directory Open Access Journal |
| issn | 2512-9465 |
| language | English |
| last_indexed | 2024-12-24T05:31:14Z |
| publishDate | 2021-01-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | TH Open |
| spelling | doaj.art-fe4f963d8c3145c5988f99f3efdf98302022-12-21T17:13:10ZengGeorg Thieme Verlag KGTH Open2512-94652021-01-010501e35e4210.1055/s-0040-1722706Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AFSake J. van der Wall0Christine Teutsch1Sergio J. Dubner2Hans-Christoph Diener3Jonathan L. Halperin4Chang Sheng Ma5Kenneth J. Rothman6Miney Paquette7Kristina Zint8Lionel Riou França9Shihai Lu10Gregory Y. H. Lip11Menno V. Huisman12Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The NetherlandsDepartment of CardioMetabolism and Respiratory Medicine, Boehringer Ingelheim International GmbH, Ingelheim, GermanyElectrophysiology Service, Clínica y Maternidad Suizo Argentina, Buenos Aires, ArgentinaFaculty of Medicine, University of Duisburg-Essen, GermanyThe Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United StatesCardiology Department, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaRTI Health Solutions, Research Triangle Institute, Research Triangle Park, North Carolina, United StatesDepartment of Medicine, Boehringer Ingelheim, Burlington, Ontario, Canada; Global Epidemiology at Boehringer Ingelheim GmbH, Ingelheim, GermanyGlobal Epidemiology Department, Boehringer Ingelheim International GmbH, Ingelheim, GermanyGlobal Epidemiology Department, Boehringer Ingelheim International GmbH, Ingelheim, GermanyBiostatistics and Data Sciences Department, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United StatesLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United KingdomDepartment of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The NetherlandsObjective Anticoagulation management in patients with atrial fibrillation (AF) and impaired renal function is challenging. This study aimed to evaluate anticoagulation prescription patterns in relation to renal function and to describe 2-year clinical outcomes among dabigatran users. Methods Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international, prospective, and observational study program involving patients with newly diagnosed AF at risk for stroke. Prescription patterns were assessed by creatinine clearance (CrCl) at enrollment. Dabigatran users were followed for 2 years. Clinical outcomes were standardized for stroke and bleeding risk, based on CHA2DS2-VASc and HAS-BLED scores, with missing values imputed. Results Baseline CrCl values were available for 12,056 of 15,308 eligible patients (79%). With declining renal function, prescriptions increased for vitamin K antagonists (VKAs) and decreased for dabigatran (30–47% and 34–12%, respectively). The prescription of other non-vitamin K antagonists remained similar across CrCl groups (14–19%). In 4,873 dabigatran users, standardized stroke rates were low across all CrCl groups; 0.58/100 patient-years (95% confidence interval [CI]: 0.30–0.90) in CrCl ≥80 mL/min, 0.85 (95% CI: 0.48–1.21) in CrCl 50 to 79 mL/min, and 0.33 (95% CI: 0.06–1.11) in CrCl 30 to 49 mL/min. Similarly, major bleeding rates were low and numerically increased with declining renal function (0.68/100 patient-years, 95% CI: 0.39–1.03; 0.92, 95% CI: 0.58–1.32; and 1.26, 95% CI: 0.66–1.97, respectively). Conclusion In patients with AF, VKA prescriptions increased and dabigatran prescriptions decreased with declining renal function. Rates of stroke and major bleeding in dabigatran patients remained low across the categories of renal impairment.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1722706atrial fibrillationanticoagulationdabigatranrenal functionstrokebleeding |
| spellingShingle | Sake J. van der Wall Christine Teutsch Sergio J. Dubner Hans-Christoph Diener Jonathan L. Halperin Chang Sheng Ma Kenneth J. Rothman Miney Paquette Kristina Zint Lionel Riou França Shihai Lu Gregory Y. H. Lip Menno V. Huisman Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF TH Open atrial fibrillation anticoagulation dabigatran renal function stroke bleeding |
| title | Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF |
| title_full | Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF |
| title_fullStr | Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF |
| title_full_unstemmed | Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF |
| title_short | Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF |
| title_sort | anticoagulation prescription and outcomes in relation to renal function in patients with atrial fibrillation results from gloria af |
| topic | atrial fibrillation anticoagulation dabigatran renal function stroke bleeding |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1722706 |
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