Reclassification, Thromboembolic, and Major Bleeding Outcomes Using Different Estimates of Renal Function in Anticoagulated Patients With Atrial Fibrillation: Insights From the PREFER-in-AF and PREFER-in-AF Prolongation Registries
| العنوان: | Reclassification, Thromboembolic, and Major Bleeding Outcomes Using Different Estimates of Renal Function in Anticoagulated Patients With Atrial Fibrillation: Insights From the PREFER-in-AF and PREFER-in-AF Prolongation Registries |
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| المؤلفون: | Giuseppe Patti, Renate B. Schnabel, Raffaele De Caterina, Jolanta M. Siller-Matula, Paulus Kirchhof, Kurt Huber, Roberto Cemin, Miklos Rohla, Ladislav Pecen |
| المصدر: | Circulation. Cardiovascular Quality and Outcomes |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Nephrology, medicine.medical_specialty, Renal function, Hemorrhage, 030204 cardiovascular system & hematology, Kidney, urologic and male genital diseases, Dabigatran, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Edoxaban, Thromboembolism, Internal medicine, Atrial Fibrillation, medicine, Humans, Registries, 030212 general & internal medicine, glomerular filtration rate, Rivaroxaban, business.industry, Editorials, creatinine, Prolongation, Atrial fibrillation, Original Articles, medicine.disease, female genital diseases and pregnancy complications, warfarin, Editorial, chemistry, Cardiology, Cardiology and Cardiovascular Medicine, business, Major bleeding, medicine.drug |
| الوصف: | Background: The Cockcroft-Gault formula is recommended to determine a renal indication for dose reduction of dabigatran, edoxaban, and rivaroxaban. Nephrology guidelines now recommend the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae as more accurate estimates of glomerular filtration rate. Methods: We analyzed anticoagulated patients with atrial fibrillation who were enrolled in the Prevention of Thromboembolic Events – European Registry in Atrial Fibrillation (PREFER in AF). The proportion of patients with dissimilar renal dosing indications was assessed when applying Cockcroft-Gault, MDRD, or CKD-EPI. Thromboembolic and major bleeding events at 1 year were compared in patients in whom Cockcroft-Gault and CKD-EPI provided concordant or discordant results around a threshold of 50 mL/minute. Results: Out of 1288 patients with atrial fibrillation with chronic kidney disease in whom Cockcroft-Gault suggested a dose reduction of dabigatran, edoxaban, or rivaroxaban (creatinine clearance ≤50 mL/minutes), 19% and 16% were reclassified to the respective higher doses, and 24% and 23% to the respective lower doses by applying the MDRD and CKD-EPI formulae, respectively. In patients potentially receiving a different dose of dabigatran, edoxaban, or rivaroxaban when using CKD-EPI, we observed an excess of thromboembolic events (4.1% versus 0.8%; odds ratio, 5.5 [95% CI, 1.5–20.8]; P =0.01). Major bleeding rates were nonsignificantly different in the discordance versus concordance group (5.7% versus 2.7%; odds ratio, 2.2 [95% CI, 0.9–5.6]; P =0.09). Conclusions: The MDRD and CKD-EPI formulae suggest a different dosing in up to a quarter of anticoagulated patients with atrial fibrillation. This seems to impact hard outcomes. |
| تدمد: | 1941-7705 1941-7713 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::637d9f4981ac4b6fcf37f56788573f64 https://doi.org/10.1161/circoutcomes.120.006852 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....637d9f4981ac4b6fcf37f56788573f64 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19417705 19417713 |
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