11 Dec Anticoagulation in Chronic Kidney Disease Patients with Atrial Fibrillation

MedicalResearch.com Interview with:
Anders Nissen Bonde MBs
Department of Cardiology
Copenhagen University Hospital Gentofte,
Gentofte, Denmark

Medical Research: What is the background for this study? What are the main findings?

Response: Patients with severe chronic kidney disease have been excluded from
randomized trials of antithrombotic therapy in atrial fibrillation.They
represent a very fragile group as they are both at increased risk of
stroke/thromboembolism and major bleedings, and previous observational
studies have had conflicting conclusions regarding the safety and benefits
of the treatment. A previous study from our department reported both
increased risk of bleeding and reduced risk of stroke with warfarin.

We wanted to assess the net clinical benefit of aspirin and warfarin in
these patients, balancing stroke and major bleeding associated with the
treatment.

Medical Research: What are the main findings?

Response: We included all danish citizens discharged with a diagnosis of atrial
fibrillation between 1997 to 2011, and divided patients according to renal
status: no renal disease, non-end-stage chronic kidney disease and renal
replacement therapy.

Chronic kidney disease has not been included in common stroke risk
stratification schemes, but both non-end-stage chronic kidney disease and
renal replacement therapy was independently associated with a higher risk
of stroke in our multiadjusted models compared to patients without kidney
disease.

Warfarin was associated with a reduction in the risk of all cause
mortality and a reduction in cardiovascular death among patients with
non-end-stage chronic kidney disease. Warfarin was associated with a
significant reduction in the risk of all cause mortality among high risk
renal replacement therapy patients. Aspirin and warfarin+aspirin was not
associated with benefit in any analysis among these patients.

Medical Research: What should clinicians and patients take away from your report?

Response: As only observational studies exist, clinicians should still be careful
when managing anticoagulant therapy in patients with atrial fibrillation
and severe chronic kidney disease, but we have conducted the largest study
in the field and we believe that our results provide guidance for optimal
thromboprophylactic treatment in this group. Severe chronic kidney disease
should not be a contraindication for warfarin therapy.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: There is a strong need for a large randomized trial in this area

Citation:

Net Clinical Benefit of Antithrombotic Therapy in Patients With Atrial
Fibrillation and Chronic Kidney Disease: A Nationwide Observational
Cohort

Anders Nissen Bonde, MB^∗; Gregory Y.H. Lip, MD^†; Anne-Lise Kamper, MD, DMSc^‡; Peter Riis Hansen, MD, PhD, DMSc^∗; Morten Lamberts, MD, PhD^∗; Kristine Hommel, MD, PhD^‡; Morten Lock Hansen, MD, PhD^∗; Gunnar Hilmar Gislason, MD, PhD^∗; Christian Torp-Pedersen, MD, DMSc^‖; Jonas Bjerring Olesen, MD, PhD^∗

Last Updated on December 11, 2014 by Marie Benz MD FAAD