Key result
Oral anticoagulation shows no stroke benefit in AF and ESRD but links to higher bleeding.
Why the study?
Atrial fibrillation is common in patients with end-stage renal disease, but the impact of oral anticoagulation on cardiovascular outcomes in this population was uncertain.
Does oral anticoagulation reduce the risk of stroke and death without increasing bleeding hospitalizations in patients with atrial fibrillation and end-stage renal disease?
Cohort (n=8,410)
Does oral anticoagulation reduce the risk of stroke and death without increasing bleeding hospitalizations in patients with atrial fibrillation and end-stage renal disease?
Hazard Ratio: 1 (95% CI 0.23–1.35)
p-value: p=0.97
In Medicare patients with atrial fibrillation and end-stage renal disease, oral anticoagulation was not associated with reduced stroke or mortality, but significantly increased the risks of bleeding hospitalization and intracranial hemorrhage.
BACKGROUND Atrial fibrillation (AF) is common in patients with end-stage renal disease (ESRD). The impact of oral anticoagulation (OAC) in ESRD patients is uncertain. OBJECTIVES The purpose of this study was to describe patterns of OAC use in ESRD patients with AF and their associations with cardiovascular outcomes. METHODS Using Medicare fee-for-service 5% claims data from 2007 to 2013, we analyzed treatment and outcomes in a cohort of patients with ESRD and AF. Prescription drug benefit information was used to determine the timing of OAC therapy. Cox proportional hazards modeling was used to compare outcomes including death, all-cause stroke, ischemic stroke, hemorrhagic stroke, and bleeding hospitalizations in ESRD patients treated with or without OAC. RESULTS The cohort included 8,410 patients with AF and ESRD. A total of 3,043 (36.2%) patients were treated with OAC at some time during the study period. Propensity scores used to match 1,519 patients with AF and ESRD on OAC with 3,018 ESRD patients without OAC. Treatment with OAC was not associated with hospitalization for stroke (hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.23 to 1.35; p = 0.97) or death (HR: 1.02; 95% CI: 0.94 to 1.10; p = 0.62). OAC was associated with an increased risk of hospitalization for bleeding (HR: 1.26; 95% CI: 1.09 to 1.46; p = 0.0017) and intracranial hemorrhage (HR: 1.30; 95% CI: 1.07 to 1.59; p = 0.0094). CONCLUSIONS OAC utilization was low in patients with AF and ESRD. We found no association between OAC use and reduced risk of stroke or death. OAC use was associated with increased risks of hospitalization for bleeding or intracranial hemorrhage. Alternative stroke prevention strategies are needed in patients with ESRD and AF.
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Pokorney et al. (2020) conducted a cohort in Atrial fibrillation and end-stage renal disease (n=8,410). Oral anticoagulation vs. No oral anticoagulation was evaluated on Hospitalization for stroke (HR 1.00, 95% CI 0.23-1.35, p=0.97). Oral anticoagulation in AF and ESRD patients was not associated with reduced stroke (HR 1.00; 95% CI 0.23-1.35) or death, but increased bleeding hospitalization (HR 1.26; p=0.0017).
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