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Updated: Jun 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
10-Year Trends of Antithrombotic Therapy Status and Clinical Outcomes in Patients With Atrial Fibrillation and Renal
Nobutoyo Masunaga1, Mitsuru Ishii1, Kouhei Oka1
1Department of Cardiology, National Hospital Organization Kyoto Medical Center.
Insights
Direct oral anticoagulants (DOACs) have changed anticoagulation for atrial fibrillation (AF). However, anticoagulation for AF patients with severe renal dysfunction has not changed, with no observed reduction in adverse events.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) revolutionized anticoagulation for atrial fibrillation (AF) starting in 2011.
- Optimal anticoagulation strategies for AF patients with severe renal dysfunction remain unclear.
- This study investigates treatment trends and outcomes in this specific patient population.
Purpose of the Study:
- To analyze the transition of anticoagulation therapy in atrial fibrillation patients with varying degrees of renal function.
- To evaluate the impact of direct oral anticoagulants (DOACs) on adverse event rates in these patients.
- To identify trends in oral anticoagulant prescription patterns based on creatinine clearance (CrCl).
Main Methods:
- Retrospective analysis of 3,706 patients from the Fushimi AF Registry.
- Patients categorized into three groups based on creatinine clearance (CrCl): ≥50 mL/min, 50-30 mL/min, and <30 mL/min.
- Comparison of oral anticoagulant prescription rates and adverse event incidence (stroke, systemic embolism, major bleeding) over time.
Main Results:
- Oral anticoagulant use, particularly DOACs, increased significantly in patients with CrCl ≥30 mL/min from 2011-2021.
- Anticoagulant prescription remained largely unchanged for patients with CrCl <30 mL/min.
- Improved safety outcomes (reduced adverse events) were observed in patients with CrCl ≥30 mL/min treated after 2014, but not in those with severe renal dysfunction (CrCl <30 mL/min).
Conclusions:
- Anticoagulation therapy for atrial fibrillation patients with severe renal dysfunction has not significantly evolved despite the advent of DOACs.
- A reduction in adverse events has not been observed in AF patients with severe renal dysfunction.
- Further research is needed to optimize anticoagulation strategies for this vulnerable patient group.
Background:
Anticoagulation therapy for atrial fibrillation (AF) has undergone major changes following the introduction of direct oral anticoagulants (DOAC) in 2011. However, the transition of anticoagulation therapy for AF patients with severe renal dysfunction remains to be elucidated.
Methods And Results:
Follow-up data, including creatinine clearance (CrCl), were available for 3,706 patients in the Fushimi AF Registry. We divided patients into 3 groups based on CrCl as follows: (1) CrCl ≥50 mL/min; (2) 50 mL/min>CrCl≥30 mL/min; and (3) CrCl <30 mL/min. In patients with CrCl ≥50 mL/min and 50>CrCl≥30 mL/min, prescription of oral anticoagulants increased year-by-year from 2011 to 2021 with a growing proportion of DOAC; however, the prescription of oral anticoagulants remained almost unchanged in those with CrCl <30 mL/min. In patients with CrCl ≥50 mL/min and 50 mL/min>CrCl≥30 mL/min, the incidence of adverse events, including stroke/systemic embolism and major bleeding, was lower among patients enrolled after 2014 than before 2013. However, these trends were not seen in patients with CrCl <30 mL/min.
Conclusions:
Despite the increased use of DOAC in patients with AF since 2011, anticoagulation therapy for AF patients with severe renal dysfunction has largely remained unchanged, and a reduction in adverse events in those patients has not been observed.
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