Key result
High estimated glomerular filtration rate (≥ 50 mL/min) was associated with a significantly lower rate of recurrent bleeding events compared to low eGFR (RR 0.738) in patients on antithrombotic therapy.
Why the study?
Simultaneously assessing thrombotic and bleeding events can be challenging and recurrent bleeding is often ignored, prompting evaluation of the effects of kidney function on outcomes during antithrombotic therapy.
Does kidney function (eGFR ≥50 vs <50 mL/min) affect the risk of recurrent bleeding events in patients with stable coronary artery disease and atrial fibrillation on antithrombotic therapy?
Cohort (n=2,092)
Open-label
Yes
Does kidney function (eGFR ≥50 vs <50 mL/min) affect the risk of recurrent bleeding events in patients with stable coronary artery disease and atrial fibrillation on antithrombotic therapy?
In patients with stable coronary artery disease and atrial fibrillation on antithrombotic therapy, decreased kidney function (eGFR <50 mL/min) is associated with a persistently higher risk of recurrent bleeding events.
Answers are grounded in this paper and cite their sources.
Low eGFR identifies higher recurrent bleeding risk on antithrombotics; leaves open whether eGFR-guided adjustments improve outcomes in stable CAD/AF.
BACKGROUND: The success of antithrombotic therapies is assessed based on thrombotic and bleeding events. Simultaneously assessing both kinds of events might be challenging, and recurrent bleeding events are often ignored. We tried to confirm the effects of kidney function on outcome events in patients undergoing antithrombotic therapy. METHODS: As a post hoc subgroup analysis of the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, a randomized clinical trial with a median follow-up of 36 months, patients were divided into high and low estimated glomerular filtration rate (eGFR) groups with a cutoff value of 50 mL/min. The cumulative incidence of bleeding and crude incidence of recurrent bleeding per 100 patient-years were calculated. We used the Cox regression model with multiple failure time data for recurrent bleeding events. RESULTS: Among 2092 patients, 1386 (66.3%) showed high eGFR. The cumulative bleeding events per 100 patients at 1 year were 5.4 and 6.2 in the high and low eGFR groups, respectively. The difference continued to increase over time. The hazard ratio for time to the first bleeding event in the high eGFR group was 0.875 (95% confidence interval 0.701-1.090, p = .234) and that for the first composite event was 0.723 (95% confidence interval 0.603-0.867, p < .000). The recurrent bleeding events per 100 person-years were 11.3 and 15.3 in the high and low eGFR groups, respectively, with a rate ratio of 0.738 (95% confidence interval 0.615-0.886, p = .001). During the observation period, the risk of bleeding changed with time. It peaked soon after the study enrollment in both groups. It decreased continuously in the high eGFR group but remained high in the low eGFR group. CONCLUSIONS: We reaffirmed that kidney function affects bleeding events in patients on antithrombotic therapy, considering recurrent events. Patients should have detailed discussions with physicians regarding the possible bleeding events when continuing antithrombotic therapy, especially in patients with decreased kidney function. TRIAL REGISTRATION: UMIN Clinical Trials Registry, UMIN000016612 . ClinicalTrials.gov, NCT02642419 . Registered on 21 October 2015.
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Matsui et al. (2022) conducted a cohort in Stable coronary artery disease with atrial fibrillation (n=2,092). High estimated glomerular filtration rate (≥ 50 mL/min) vs. Low estimated glomerular filtration rate (< 50 mL/min) was evaluated on Recurrent bleeding events per 100 person-years (Rate ratio 0.738, 95% CI 0.615-0.886, p=0.001). High estimated glomerular filtration rate (≥ 50 mL/min) was associated with a significantly lower rate of recurrent bleeding events compared to low eGFR (RR 0.738) in patients on antithrombotic therapy.
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