Clinical outcomes of anticoagulation and refining risk stratification for stroke in patients with advanced chronic kidney disease and atrial fibrillation

Abstract

Abstract Background: We aimed to elucidate the effects of anticoagulation therapy in patients with atrial fibrillation (AF) according to the difference in renal function and define a chronic kidney disease (CKD) population that could benefit from anticoagulation therapy. Methods: Using datasets from the Asan Biomedical Research Environment Database between 2006 and 2017, 12,641 patients with nonvalvular AF were analyzed. The primary outcome was the net clinical outcome, defined as a composite of all-cause mortality, thromboembolic events, and major bleeding. Results: Patients were categorized into groups according to their baseline creatinine clearance. There was a trend for a progressive increase in the prevalence of stroke or systemic embolism, major bleeding, and all-cause mortality as the renal function deteriorated. The clinical benefit of anticoagulation therapy was the most prominent in patients with normal renal function and was reduced in those with advanced-stage CKD. Among CKD 5 patients, the benefit of anticoagulation therapy was only evident in those with a very high risk of embolism (CHA2DS2-VASc score ≥4). Conclusion: Advanced CKD is associated with a higher risk of the net clinical outcome. The clinical benefit of anticoagulation therapy reduces with the increasing degree of CKD. In CKD5, anticoagulation should be considered in high risk of embolism.