Key Points
- To evaluate temporal trends in oral anticoagulant prescribing among patients with atrial fibrillation and advanced chronic kidney disease.
- Retrospective single-center registry analysis of 179 patients with atrial fibrillation and an eGFR below 30 ml/min/1.73 m² enrolled between 2014 and 2022 in the CRAFT registry cohort.
- Evaluated annual prescribing patterns at hospital discharge for apixaban 2.5 mg twice daily, rivaroxaban 15 mg once daily, and vitamin K antagonists.
- Apixaban 2.5 mg twice daily was the most commonly prescribed anticoagulant (58.1%), followed by vitamin K antagonists (24.6%) and rivaroxaban 15 mg once daily (17.3%).
- Apixaban 2.5 mg twice daily showed a statistically significant estimated increase of 3.88 patients per year (b = 3.88; P <0.001).
Study Design
TypeObservational (n=191)
Structured PICO
PPopulation191 adult patients (64.4% female, nearly three-quarters aged ≥75 years) hospitalized with nonvalvular atrial fibrillation and advanced CKD (eGFR <30 ml/min/1.73 m²) at a Polish district hospital between 2014 and 2022.
EExposureOral anticoagulant therapy prescribed at hospital discharge, specifically direct oral anticoagulants (apixaban 2.5 mg oral twice daily or rivaroxaban 15 mg oral once daily) or vitamin K antagonists (VKAs)
OOutcomeContemporary oral anticoagulant prescribing patterns and temporal trends in the absolute annual numbers of patients receiving each anticoagulant between 2014 and 2022
Main Result
Effect estimate: b = 3.88 patients/year
Absolute Event Rate: 58.1% vs 24.6%
p-value: p=<0.001
In real-world Polish clinical practice between 2014 and 2022, oral anticoagulant prescribing for patients with atrial fibrillation and advanced CKD shifted significantly toward apixaban 2.5 mg twice daily despite a persistent lack of randomized trial evidence in this population.
Limitations
- Retrospective observational design precludes causal inference
- Reliance on registry data and completeness/accuracy of routine clinical documentation
- Single-center study limiting generalizability
- Prescribing patterns assessed only at hospital discharge without follow-up on therapy changes or clinical outcomes
- Small sample size of patients with CKD stages G4-G5d limiting statistical power
- Analysis was based on registry data and depended on the completeness and accuracy of routinely collected clinical documentation
- Conducted at a single center, which may limit generalizability
- Prescribing patterns were assessed only at hospital discharge, without information on subsequent therapy changes or clinical outcomes (bleeding and thromboembolic events) during follow-up
- Relatively small number of patients with CKD stages G4–G5d limited statistical power to detect smaller differences in temporal prescribing trends