Scholarlink

Background <p>Chronic kidney disease (CKD) often coexists in patients with atrial fibrillation (AF), worsening patients’ prognosis. Direct oral anticoagulants (DOACs) are increasingly used also in patients with AF and CKD, but limited evidence exists regarding outcomes in advanced CKD.</p> Methods <p>Patients with AF and CKD from the Italian prospective nationwide START registry were included. Patients were divided into three groups based on the estimated glomerular filtration rate (eGFR): (1) eGFR 59–46, (2) 45–30, and (3) 29–15&#xa0;ml/min/1.73 m<sup>2</sup>. The association of DOACs or vitamin K antagonists (VKAs) use with all-cause mortality, cardiovascular events (CVEs), and bleedings was assessed using Cox regression and Fine-Gray competing risk models. Propensity score matching (PSM) was used to confirm the robustness of the analysis.</p> Results <p>Among 4849 patients with AF and CKD, the mean age was 81.5 ± 6.7&#xa0;years, 57.9% were women, and 55.8% were on DOACs. DOAC (vs. VKAs) was inversely associated with all-cause mortality in group 1 (HR 0.49, 95% CI 0.36–0.67, <i>p</i> &lt; 0.001), group 2 (HR 0.42, 95% CI 0.31–0.58, <i>p</i> &lt; 0.001), and group 3 (HR 0.20, 95% CI 0.10–0.39, <i>p</i> &lt; 0.001). Similar results were obtained for CVEs (sHR 0.64, 95% CI 0.49–0.85, <i>p</i> = 0.002 for group 1, sHR 0.56, 95% CI 0.42–0.75, <i>p</i> &lt; 0.001 for group 2, sHR 0.31, 95% CI 0.17–0.55, <i>p</i> &lt; 0.001 for group 3), while no differences emerged for bleedings. No significant differences were observed among DOACs.</p> Conclusions <p>In this real-world contemporary cohort of patients with AF receiving oral anticoagulants, DOAC use was associated with a lower risk of all-cause mortality and cardiovascular events across all stages of CKD.</p> <p>Trial registration</p> <p>NCT02219984</p> Graphical abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Real-world use of direct oral anticoagulants in atrial fibrillation patients with moderate/severe chronic kidney disease: a propensity score matched analysis from the START registry

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月3日

查看全文
  • Danilo Menichelli,
  • Gianluca Gazzaniga,
  • Daniela Poli,
  • Gualtiero Palareti,
  • Emilia Antonucci,
  • Arianna Pani,
  • Pasquale Pignatelli,
  • Daniele Pastori,
  • Benilde Cosmi,
  • Daniela Poli,
  • Elena Lotti,
  • Martina Berteotti,
  • Rossella Marcucci,
  • Walter Ageno,
  • Giovanna Colombo,
  • Doris Barcellona,
  • Giovanni Barillari,
  • Salvatore Bradamante,
  • Eugenio Bucherini,
  • Monica Vastola,
  • Luca Bucherini,
  • Paola Casasco,
  • Antonio Ciampa,
  • Antonio Chistolini,
  • Alessandra Serrao,
  • Luciano Crippa,
  • Raimondo De Cristofaro,
  • Erica De Candia,
  • Valeria De Micheli,
  • Igor Diemberger,
  • Giuseppe Boriani,
  • Marcello Di Nisio,
  • Anna Falanga,
  • Teresa Lerede,
  • Elvira Grandone,
  • Donatella Colaizzo,
  • Antonio Insana,
  • Nicola Lucio Liberato,
  • Domenico Lione,
  • Rosa Maria Lombardi,
  • Giacomo Lucarelli,
  • Giuseppe Malcangi,
  • Catello Mangione,
  • Giuliana Martini,
  • Marco Marzolo,
  • Giovanni Nante,
  • Vincenzo Oriana,
  • Carmelo Paparo,
  • Paolo Pedico,
  • Simona Pedrini,
  • Vittorio Pengo,
  • Antonietta Piana,
  • Francesco Cibecchini,
  • Simona Pezzella,
  • Pasquale Pignatelli,
  • Daniele Pastori,
  • Vincenza Rossi,
  • Lucia Ruocco,
  • Paolo Chiarugi,
  • Serena Rupoli,
  • Domizio Serra,
  • Servizio Analisi,
  • Carmine Spataro,
  • Margherita Reduzzi,
  • Chiara ambaglio ,
  • Sophie Testa,
  • Oriana Paoletti

摘要

Background

Chronic kidney disease (CKD) often coexists in patients with atrial fibrillation (AF), worsening patients’ prognosis. Direct oral anticoagulants (DOACs) are increasingly used also in patients with AF and CKD, but limited evidence exists regarding outcomes in advanced CKD.

Methods

Patients with AF and CKD from the Italian prospective nationwide START registry were included. Patients were divided into three groups based on the estimated glomerular filtration rate (eGFR): (1) eGFR 59–46, (2) 45–30, and (3) 29–15 ml/min/1.73 m2. The association of DOACs or vitamin K antagonists (VKAs) use with all-cause mortality, cardiovascular events (CVEs), and bleedings was assessed using Cox regression and Fine-Gray competing risk models. Propensity score matching (PSM) was used to confirm the robustness of the analysis.

Results

Among 4849 patients with AF and CKD, the mean age was 81.5 ± 6.7 years, 57.9% were women, and 55.8% were on DOACs. DOAC (vs. VKAs) was inversely associated with all-cause mortality in group 1 (HR 0.49, 95% CI 0.36–0.67, p < 0.001), group 2 (HR 0.42, 95% CI 0.31–0.58, p < 0.001), and group 3 (HR 0.20, 95% CI 0.10–0.39, p < 0.001). Similar results were obtained for CVEs (sHR 0.64, 95% CI 0.49–0.85, p = 0.002 for group 1, sHR 0.56, 95% CI 0.42–0.75, p < 0.001 for group 2, sHR 0.31, 95% CI 0.17–0.55, p < 0.001 for group 3), while no differences emerged for bleedings. No significant differences were observed among DOACs.

Conclusions

In this real-world contemporary cohort of patients with AF receiving oral anticoagulants, DOAC use was associated with a lower risk of all-cause mortality and cardiovascular events across all stages of CKD.

Trial registration

NCT02219984

Graphical abstract