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Published on: February 26, 2013
Oral Anticoagulation in Patients with Chronic Kidney Disease and Non-Valvular Atrial Fibrillation: The FAERC Study
Marco Montomoli1, Lourdes Roca2, Mariana Rivera3
1Nephrology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez 17, 46010 Valencia, Spain.
Insights
Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients. Direct-acting oral anticoagulants (DOACs) reduced stroke risk compared to coumarins, with similar safety profiles for bleeding and mortality.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) is the most common arrhythmia in patients with chronic kidney disease (CKD).
- AF presence in CKD patients increases the risk of stroke and mortality.
Purpose of the Study:
- To determine the prevalence of non-valvular AF in a Spanish CKD cohort.
- To compare the effectiveness and safety of direct-acting oral anticoagulants (DOACs) versus coumarins in CKD patients with AF.
Main Methods:
- Retrospective multicentre analysis of historical cohorts (FAERC study).
- Analysis of a Spanish cohort of 4749 CKD patients followed in nephrology clinics.
- Data collected from arrhythmia diagnosis onwards.
Main Results:
- Prevalence of non-valvular AF was 12.2% in the CKD cohort.
- 98.6% of patients received anticoagulant treatment, primarily coumarins (79.7%).
- DOACs were associated with fewer cerebrovascular events than acenocoumarol, with no significant differences in bleeding, coronary events, or mortality.
Conclusions:
- Atrial fibrillation is highly prevalent in patients with renal disease.
- Direct-acting anticoagulants appear to reduce ischemic-embolic complications in CKD patients with AF.
- No significant differences in bleeding, coronary events, or mortality were observed between anticoagulant types.
Abstract:
Atrial fibrillation (AF) is the most common arrhythmia in patients with chronic kidney disease (CKD), and its presence is associated with a higher risk of stroke and mortality.
Material And Methods:
The FAERC study performed a retrospective multicentre analysis of historical cohorts in which data were collected from arrhythmia diagnosis onwards.
Results:
We analysed a Spanish cohort of 4749 patients with CKD (mean eGFR 33.9 mL/min) followed up in the nephrology clinic, observing a 12.2% prevalence of non-valvular AF. In total, 98.6% of these patients were receiving anticoagulant treatment, mainly with coumarins (79.7%). Using direct-acting oral anticoagulants (DOACs) was associated with fewer cerebrovascular events than using acenocoumarol, but in contrast with other studies, we could not corroborate the association of risk of bleeding, coronary events, or death with a type of anticoagulant prescribed.
Conclusions:
Atrial fibrillation is highly prevalent in renal patients. Direct-acting anticoagulants seem to be associated with fewer ischemic-embolic complications, with no differences in bleeding, coronary events, or mortality rates.
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