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Secondary stroke prophylaxis in atrial fibrillation patients with chronic kidney disease: a nationwide cohort study

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@article{2e77b691c8ed401a97416d1f4ec7e146,
title = "Secondary stroke prophylaxis in atrial fibrillation patients with chronic kidney disease: a nationwide cohort study",
abstract = "AIMS: Oral anticoagulation (OAC) therapy as secondary stroke prophylaxis in atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unexplored and poses a clinical treatment dilemma. We assessed the long-term risk of thromboembolic events according to post-stroke OAC therapy in AF patients with CKD after their first ischaemic stroke.METHODS AND RESULTS: We identified Danish AF patients with CKD who presented with first-time ischaemic stroke from 2005 to 2014. Chronic kidney disease was defined as a diagnosis code for CKD before baseline, defined as 100 days after stroke discharge. Post-stroke antithrombotic therapy (OAC therapy and antiplatelet therapy) was identified from prescription claims from discharge to baseline. Cumulative incidences and adjusted hazard ratios (HRs) of thromboembolic events according to post-stroke OAC therapy were examined. Of 1252 AF patients with CKD presenting with ischaemic stroke, 631 (50.4{\%}) patients were on OAC therapy and 621 (49.6{\%}) were on antiplatelet therapy alone at baseline [median age 76 (interquartile range, IQR 71-83) and 80 (IQR 72-86), respectively]. The median follow-up period was 1.9 years (IQR 0.8-3.6). Cumulative incidence rates of thromboembolic events and bleeding showed no significant difference between those on OAC therapy and antiplatelet therapy. The results from the multivariable analysis revealed similar results: thromboembolic risk was not modified by OAC treatment [adjusted HR 0.89, 95{\%} confidence interval (CI) 0.73-1.09] nor was the risk of bleeding (adjusted HR 0.88, 95{\%} CI 0.67-1.17).CONCLUSION: Oral anticoagulation in patients with CKD and prior stroke was not associated with a reduced risk of recurrent thromboembolic events compared with antiplatelet therapy.",
keywords = "Chronic kidney disease, Ischaemic stroke, Oral anticoagulation therapy, Secondary prevention, Stroke prevention",
author = "Christensen, {Mathias Aagaard} and Fosb{\o}l, {Emil Loldrup} and Bonde, {Anders Nissen} and Olesen, {Jonas Bjerring} and Gislason, {Gunnar H} and Christian Torp-Pedersen and Anna Gundlund",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\circledC} The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.",
year = "2020",
month = "5",
day = "1",
doi = "10.1093/europace/euz340",
language = "English",
volume = "22",
pages = "716--723",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "5",

}

RIS

TY - JOUR

T1 - Secondary stroke prophylaxis in atrial fibrillation patients with chronic kidney disease

T2 - a nationwide cohort study

AU - Christensen, Mathias Aagaard

AU - Fosbøl, Emil Loldrup

AU - Bonde, Anders Nissen

AU - Olesen, Jonas Bjerring

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

AU - Gundlund, Anna

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2020/5/1

Y1 - 2020/5/1

N2 - AIMS: Oral anticoagulation (OAC) therapy as secondary stroke prophylaxis in atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unexplored and poses a clinical treatment dilemma. We assessed the long-term risk of thromboembolic events according to post-stroke OAC therapy in AF patients with CKD after their first ischaemic stroke.METHODS AND RESULTS: We identified Danish AF patients with CKD who presented with first-time ischaemic stroke from 2005 to 2014. Chronic kidney disease was defined as a diagnosis code for CKD before baseline, defined as 100 days after stroke discharge. Post-stroke antithrombotic therapy (OAC therapy and antiplatelet therapy) was identified from prescription claims from discharge to baseline. Cumulative incidences and adjusted hazard ratios (HRs) of thromboembolic events according to post-stroke OAC therapy were examined. Of 1252 AF patients with CKD presenting with ischaemic stroke, 631 (50.4%) patients were on OAC therapy and 621 (49.6%) were on antiplatelet therapy alone at baseline [median age 76 (interquartile range, IQR 71-83) and 80 (IQR 72-86), respectively]. The median follow-up period was 1.9 years (IQR 0.8-3.6). Cumulative incidence rates of thromboembolic events and bleeding showed no significant difference between those on OAC therapy and antiplatelet therapy. The results from the multivariable analysis revealed similar results: thromboembolic risk was not modified by OAC treatment [adjusted HR 0.89, 95% confidence interval (CI) 0.73-1.09] nor was the risk of bleeding (adjusted HR 0.88, 95% CI 0.67-1.17).CONCLUSION: Oral anticoagulation in patients with CKD and prior stroke was not associated with a reduced risk of recurrent thromboembolic events compared with antiplatelet therapy.

AB - AIMS: Oral anticoagulation (OAC) therapy as secondary stroke prophylaxis in atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unexplored and poses a clinical treatment dilemma. We assessed the long-term risk of thromboembolic events according to post-stroke OAC therapy in AF patients with CKD after their first ischaemic stroke.METHODS AND RESULTS: We identified Danish AF patients with CKD who presented with first-time ischaemic stroke from 2005 to 2014. Chronic kidney disease was defined as a diagnosis code for CKD before baseline, defined as 100 days after stroke discharge. Post-stroke antithrombotic therapy (OAC therapy and antiplatelet therapy) was identified from prescription claims from discharge to baseline. Cumulative incidences and adjusted hazard ratios (HRs) of thromboembolic events according to post-stroke OAC therapy were examined. Of 1252 AF patients with CKD presenting with ischaemic stroke, 631 (50.4%) patients were on OAC therapy and 621 (49.6%) were on antiplatelet therapy alone at baseline [median age 76 (interquartile range, IQR 71-83) and 80 (IQR 72-86), respectively]. The median follow-up period was 1.9 years (IQR 0.8-3.6). Cumulative incidence rates of thromboembolic events and bleeding showed no significant difference between those on OAC therapy and antiplatelet therapy. The results from the multivariable analysis revealed similar results: thromboembolic risk was not modified by OAC treatment [adjusted HR 0.89, 95% confidence interval (CI) 0.73-1.09] nor was the risk of bleeding (adjusted HR 0.88, 95% CI 0.67-1.17).CONCLUSION: Oral anticoagulation in patients with CKD and prior stroke was not associated with a reduced risk of recurrent thromboembolic events compared with antiplatelet therapy.

KW - Chronic kidney disease

KW - Ischaemic stroke

KW - Oral anticoagulation therapy

KW - Secondary prevention

KW - Stroke prevention

U2 - 10.1093/europace/euz340

DO - 10.1093/europace/euz340

M3 - Journal article

VL - 22

SP - 716

EP - 723

JO - Europace

JF - Europace

SN - 1099-5129

IS - 5

ER -

ID: 58719291