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Rohla, Miklos; Pecen, Ladislav; Cemin, Roberto; Patti, Giuseppe; Siller-Matula, Jolanta M.; Schnabel, Renate B.; Huber, Kurt; Kirchhof, Paulus; De Caterina, Raffaele

Reclassification, Thromboembolic, and Major Bleeding Outcomes Using Different Estimates of Renal Function in Anticoagulated Patients With Atrial Fibrillation: Insights From the PREFER-in-AF and PREFER-in-AF Prolongation Registries

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  • Medientyp: E-Artikel
  • Titel: Reclassification, Thromboembolic, and Major Bleeding Outcomes Using Different Estimates of Renal Function in Anticoagulated Patients With Atrial Fibrillation: Insights From the PREFER-in-AF and PREFER-in-AF Prolongation Registries
  • Beteiligte: Rohla, Miklos; Pecen, Ladislav; Cemin, Roberto; Patti, Giuseppe; Siller-Matula, Jolanta M.; Schnabel, Renate B.; Huber, Kurt; Kirchhof, Paulus; De Caterina, Raffaele
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2021
  • Erschienen in: Circulation: Cardiovascular Quality and Outcomes
  • Sprache: Englisch
  • DOI: 10.1161/circoutcomes.120.006852
  • ISSN: 1941-7713; 1941-7705
  • Schlagwörter: Cardiology and Cardiovascular Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec> <jats:title>Background:</jats:title> <jats:p>The Cockcroft-Gault formula is recommended to determine a renal indication for dose reduction of dabigatran, edoxaban, and rivaroxaban. Nephrology guidelines now recommend the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae as more accurate estimates of glomerular filtration rate.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>We analyzed anticoagulated patients with atrial fibrillation who were enrolled in the Prevention of Thromboembolic Events – European Registry in Atrial Fibrillation (PREFER in AF). The proportion of patients with dissimilar renal dosing indications was assessed when applying Cockcroft-Gault, MDRD, or CKD-EPI. Thromboembolic and major bleeding events at 1 year were compared in patients in whom Cockcroft-Gault and CKD-EPI provided concordant or discordant results around a threshold of 50 mL/minute.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> Out of 1288 patients with atrial fibrillation with chronic kidney disease in whom Cockcroft-Gault suggested a dose reduction of dabigatran, edoxaban, or rivaroxaban (creatinine clearance ≤50 mL/minutes), 19% and 16% were reclassified to the respective higher doses, and 24% and 23% to the respective lower doses by applying the MDRD and CKD-EPI formulae, respectively. In patients potentially receiving a different dose of dabigatran, edoxaban, or rivaroxaban when using CKD-EPI, we observed an excess of thromboembolic events (4.1% versus 0.8%; odds ratio, 5.5 [95% CI, 1.5–20.8]; <jats:italic>P</jats:italic> =0.01). Major bleeding rates were nonsignificantly different in the discordance versus concordance group (5.7% versus 2.7%; odds ratio, 2.2 [95% CI, 0.9–5.6]; <jats:italic>P</jats:italic> =0.09). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>The MDRD and CKD-EPI formulae suggest a different dosing in up to a quarter of anticoagulated patients with atrial fibrillation. This seems to impact hard outcomes.</jats:p> </jats:sec>
  • Zugangsstatus: Freier Zugang