Key result
Patients with nonvalvular atrial fibrillation and renal impairment were significantly more likely to not receive any anticoagulant therapy compared to those without renal impairment (30.1% vs 26.4%, P=0.003).
Observational
Yes
Patients with nonvalvular atrial fibrillation and renal impairment are undertreated with anticoagulants in real-world practice despite having a higher risk of thromboembolism.
AF patients with renal impairment receive less anticoagulation; hypothesis-generating for strategies to address undertreatment in this high-risk group.
BACKGROUND: The data regarding stroke prevention strategies in nonvalvular atrial fibrillation (NVAF) are limited especially in patients with renal impairment (RI). We sought to evaluate management dilemmas in patients with concurrent NVAF and RI in RAMSES (ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies inTurkey) study. METHODS: We conducted a prospective, multicenter, nation-wide registry in NVAF patients in outpatient cardiology clinics. All consecutive patients with NVAF were enrolled in RAMSES study (ClinicalTrials.gov identifier NCT02344901). The baseline data were collected. Glomerular filtration rate (GFR) was estimated by Cockcroft-Gault equation. RESULTS: VASc and HAS-BLED scores compared to those without RI (3·9 ± 1·5 vs. 2·9 ± 1·5, and 2·0 ± 1 vs. 1·4 ± 1; P < 0·001). Prior history of major bleeding (6·9% vs. 4·1%, P < 0·001) and stroke (16·2% vs. 11·8%, P < 0·001) was significantly higher among individuals with concomitant RI and NVAF. Although RI patients had a higher risk for thromboembolism, number of the patients who did not receive any anticoagulant therapy was higher in patients with RI than without RI (30·1 vs. 26·4%, P = 0·003). CONCLUSION: RAMSES study showed that one-third of the patients with NVAF had RI in the real-world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one-third of these patients did not receive any anticoagulant therapy.
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Mert et al. (2017) conducted an observational in Nonvalvular atrial fibrillation. Renal impairment vs. No renal impairment was evaluated on Not receiving any anticoagulant therapy (p=0.003). Patients with nonvalvular atrial fibrillation and renal impairment were significantly more likely to not receive any anticoagulant therapy compared to those without renal impairment (30.1% vs 26.4%, P=0.003).
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