Oral anticoagulant monotherapy was associated with a lower risk of major adverse cardiovascular events compared with dual therapy (HR 0.84; 95% CI 0.81-0.88) in advanced CKD, AF, and CAD.
Cohort (n=25,178)
Yes
Does oral anticoagulant monotherapy reduce cardiovascular and bleeding risks compared to dual antithrombotic therapy in adults with advanced CKD, AF, and CAD?
In patients with advanced CKD, AF, and CAD, OAC monotherapy is associated with lower cardiovascular and bleeding risks compared to dual antithrombotic therapy.
Effect estimate: HR 0.84 (95% CI 0.81-0.88)
OBJECTIVE: To compare the effectiveness and safety of oral anticoagulant (OAC) monotherapy vs dual antithrombotic therapy (OAC plus a single antiplatelet) in patients with advanced chronic kidney disease (CKD) with atrial fibrillation (AF) and coronary artery disease (CAD). PATIENTS AND METHODS: We conducted a retrospective cohort study using TriNetX data from March 1, 2005, through April 1, 2024. Adults with advanced CKD (stages 4 and 5 or dialysis dependent) with AF and CAD were included. Patients treated with OAC monotherapy or dual therapy were matched 1:1 by propensity scores and observed for 12 months. Efficacy outcomes included major adverse cardiovascular events, ischemic stroke, and acute myocardial infarction; safety outcomes were major bleeding, minor bleeding, and intracranial hemorrhage. RESULTS: Of 57,447 patients (13,920 OAC monotherapy; 43,527 dual therapy), 12,589 matched pairs were analyzed. At 12 months, OAC monotherapy was associated with lower risks of major adverse cardiovascular events (hazard ratio HR, 0.84; 95% CI, 0.81 to 0.88), acute ischemic stroke (HR, 0.67; 95% CI, 0.62 to 0.73), and acute myocardial infarction (HR, 0.48; 95% CI, 0.44 to 0.53). Safety outcomes also favored OAC monotherapy, with reduced risk of major bleeding (2.5% vs 3.1%; risk difference RD, -0.5%; 95% CI, -0.9 to -0.1%), minor bleeding (15.5% vs 19.8%; RD, -4.3%; 95% CI, -5.2 to -3.2%), and intracranial hemorrhage (1.4% vs 1.9%; RD, -0.4; 95% CI, -0.7 to -0.1%). CONCLUSION: In patients with advanced CKD, AF, and CAD, OAC monotherapy was associated with lower cardiovascular and bleeding risks compared with dual therapy, supporting its use as a safer and effective strategy in this high-risk population.
Kao et al. (Sat,) conducted a cohort in Advanced chronic kidney disease with atrial fibrillation and coronary artery disease (n=25,178). Oral anticoagulant (OAC) monotherapy vs. Dual antithrombotic therapy (OAC plus a single antiplatelet) was evaluated on Major adverse cardiovascular events (HR 0.84, 95% CI 0.81-0.88). Oral anticoagulant monotherapy was associated with a lower risk of major adverse cardiovascular events compared with dual therapy (HR 0.84; 95% CI 0.81-0.88) in advanced CKD, AF, and CAD.