Related Experiment Video
Updated: May 30, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Secondary Prevention of Stroke in Patients with Non-Valvular Atrial Fibrillation and Advanced Chronic Kidney Disease
Yanzhao Ren1,2, Menglong Miao1, Ruopeng Tan1
1Department of Cardiology, the First Affiliated Hospital of Dalian Medical University.
Insights
For atrial fibrillation patients with advanced chronic kidney disease and prior stroke, anticoagulant therapy significantly reduces ischemic stroke risk and mortality compared to no treatment or antiplatelet therapy.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Limited evidence exists for anticoagulant therapy in atrial fibrillation (AF) patients with advanced chronic kidney disease (CKD).
- Clinical application of anticoagulants in this high-risk population remains controversial.
- Patients with AF and advanced CKD (G4-G5) and prior stroke are a vulnerable group requiring optimized treatment strategies.
Purpose of the Study:
- To evaluate the benefits and safety of different antithrombotic therapies in AF patients with advanced CKD and a history of stroke.
- To compare anticoagulant therapy (warfarin, NOACs) with antiplatelet therapy and no antithrombotic treatment.
- To assess the impact on subsequent ischemic stroke, bleeding events, and all-cause mortality.
Main Methods:
- Retrospective cohort study of 570 AF patients with advanced CKD (G4-G5) and prior stroke.
- Patients were categorized into four groups: warfarin, non-vitamin K antagonist oral anticoagulant (NOAC), antiplatelet therapy, and control (no antithrombotic therapy).
- Long-term clinical outcomes including ischemic stroke, bleeding, and all-cause death were compared.
Main Results:
- Anticoagulant therapy (warfarin and NOACs) significantly decreased ischemic stroke risk compared to no treatment.
- Antiplatelet therapy did not show a significant reduction in ischemic stroke risk.
- Anticoagulant therapy was associated with significantly lower all-cause mortality than no antithrombotic or antiplatelet therapy.
- NOAC therapy demonstrated a significant decrease in bleeding risk compared to warfarin.
Conclusions:
- Anticoagulant therapy is associated with reduced risk of recurrent ischemic stroke in AF patients with advanced CKD and prior stroke.
- Anticoagulants lead to lower mortality rates compared to no antithrombotic treatment or antiplatelet therapy in this patient group.
- NOACs offer a potentially safer alternative with reduced bleeding risk compared to warfarin.
Aims:
Evidence supporting the prescription of anticoagulant therapy for patients with atrial fibrillation (AF) with advanced chronic kidney disease (CKD) has been limited, and its clinical application in this context remains controversial.
Methods:
We identified AF patients with advanced CKD (G4-G5) and a history of stroke who were admitted to the First Affiliated Hospital of Dalian Medical University between January 1, 2011, and June 30, 2023. Patients were classified into warfarin, non-vitamin K antagonist oral anticoagulant (NOAC), antiplatelet therapy, and control (no antithrombotic therapy) groups. We evaluated the benefits and safety of different antithrombotic therapies by comparing the long-term clinical outcome measures, including the incidence of subsequent ischemic stroke events, bleeding, and all-cause death.
Results:
In total, 570 patients were included. In this cohort, 87 (15.3%) patients had no antithrombotic treatment, 252 (44.2%) received antiplatelet therapy, 105 (18.4%) received warfarin, and 126 (22.1%) received NOAC therapy. Compared with patients without treatment, we found that treatment with anticoagulant therapy significantly decreased the risk of ischemic stroke, but antiplatelet therapy did not. Treatment with anticoagulant therapy was associated with significantly lower mortality than no antithrombotic therapy or antiplatelet therapy , at least within the study period. Furthermore, compared with warfarin treatment, patients treated with NOAC therapy showed a significant decrease in the incidence of bleeding risks.
Conclusion:
Among AF patients with advanced CKD and prior stroke, receiving anticoagulants resulted in a reduced risk of recurrent ischemic stroke events than no antithrombotic treatment, and lower mortality than no antithrombotic treatment or antiplatelet therapy.
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:25Antihypertensive Drugs: Direct Renin Inhibitors