Does oral anticoagulant use reduce all-cause death in patients with end-stage kidney disease and atrial fibrillation?
In patients with end-stage kidney disease and atrial fibrillation, oral anticoagulation is associated with reduced risks of all-cause death, ischemic stroke, and MACE without increasing major bleeding.
Background: The prevalence of atrial fibrillation (AF) in patients with end-stage kidney disease (ESKD) is high and increasing. However, evidence regarding oral anticoagulant (OAC) use in these patients is insufficient and conflicting. Methods: This retrospective cohort study included patients in the Korea National Health Insurance System diagnosed with AF after ESKD onset from January 2007 to December 2017. The primary outcome was all-cause death. Secondary outcomes were ischaemic stroke, hospitalization for major bleeding and major adverse cardiovascular events (MACE). Outcomes were compared between OAC users and non-users using 6-month landmark analysis and 1: 3 propensity score matching (PSM). Results: = 8341) and the proportion of direct OACs prescribed increased steadily from 0% in 2012 to 51. 4% in 2018. After PSM, OAC users had a lower risk of all-cause death hazard ratio HR 0. 67 95% confidence interval (CI) 0. 55-0. 81, ischaemic stroke HR 0. 61 (95% CI 0. 41-0. 89) and MACE HR 0. 70 (95% CI 0. 55-0. 90) and no increased risk of hospitalization for major bleeding HR 0. 99 (95% CI 0. 72-1. 35) compared with non-users. Unlike warfarin, direct OACs were associated with a reduced risk of all-cause death and hospitalization for major bleeding. Conclusions: In patients with ESKD and AF, OACs were associated with reduced all-cause death, ischaemic stroke and MACE.
Kim et al. (Thu,) studied this question.