Bleeding Risk in Anticoagulated Patients with Non-Valvular Atrial Fibrillation and Chronic Kidney Disease in Thai Population
Vasunun Thienpugdikul, MD¹, Katiman Sonthikaew, MD¹, Pattama Sahasoonthorn, PharmD², Warisara Pangprasert, PharmD², Teetouch Ananwattanasuk MD¹, Padoemwut Teerawongsakul, MD, MSc¹
Affiliation : ¹ Department of Internal Medicine, Navamindradhiraj University, Bangkok, Thailand, ² Department of Pharmacy, Vajira Hospital, Bangkok, Thailand
Objective: Atrial fibrillation (AF) and chronic kidney disease (CKD) both increase the risk of stroke, cardiovascular morbidity, and mortality. Oral anticoagulants are effective in preventing stroke in AF patients but are associated with increased risk of bleeding, especially in those with comorbid CKD. The present study aimed to compare the incidence of bleeding events in patients with non-valvular atrial fibrillation (NVAF), either with or without CKD, receiving either warfarin or nonvitamin K antagonist oral anticoagulants (NOACs).
Materials and Methods: This retrospective cohort study enrolled NVAF patients between January 2016 and March 2021. Baseline characteristics and type and dosage of anticoagulants received were analyzed. Data were presented as mean ± standard deviation (SD) and compared using Chi-square tests. Cox proportional hazard models were used to assess the incidence of bleeding events.
Results: A total of 218 patients were included, of whom 122 (56.0%) were female. The average age was 72 years. There were 95 (43.6%) patients with CKD, mostly stage 3a 20.6%. Warfarin was given to 121 patients (55.5%), while NOACs were given to 97 patients (44.5%). The mean time in therapeutic range (TTR) in warfarin groups for patients with and without CKD was equal (34.2 vs. 34.7, p=0.74). There was no significant difference between patients with and without CKD in the incidence of overall major bleeding (12.8% vs. 7.3%, p=0.18), gastrointestinal bleeding (7.4% vs. 5.7%, p=0.60), intracranial hemorrhage (1.1% vs. 0.8%, p=0.85), or other major bleeding (4.2% vs. 0.8%, p=0.10), The incidence of major bleeding events was not significantly different between patients treated with NOACs and warfarin (11.5% vs. 8.3%, adjusted HR 0.72, p=0.45).
Conclusion: The bleeding risk in anticoagulated NVAF patients with mild to moderate CKD is not significantly different from that in those with normal kidney function.
Received 15 May 2024 | Revised 9 September 2024 | Accepted 10 September 2024
Keywords : Atrial fibrillation; Chronic kidney disease; Major bleeding, Oral anticoagulants
