Abstract
Background and objectives: Recent randomized trials of oral antithrombotic drugs with atrial flutter (AFL) excluded patients with renal impairment because of their increased risk of bleeding. To date, no relevant studies have assessed the effectiveness and safety of different antithrombotic drugs in chronic kidney disease (CKD) patients with AFL. This cohort study evaluated the effectiveness and safety of different antithrombotic drugs in CKD patients with AFL. This study also investigated the risk of cardiovascular events from antithrombotic drugs through different risk profiles of stroke stratified by the CHA2DS2-VASc score. Materials and Methods: This cohort study was performed in patients with AFL and CKD who were extracted from the National Health Insurance (NHI) Database in Taiwan. Oral antithrombotic therapy (oral anticoagulants (OAC) or antiplatelets (APT)) was administered to patients who had been diagnosed with AFL after being diagnosed with CKD between 2011 and 2015. Primary outcomes, including ischemic stroke, systemic embolism, and composite of stroke, and secondary outcomes, including major adverse cardiac events (MACEs), major bleeding, all-cause mortality, and cardiovascular-related death, were examined. Results: A total of 2468 patients were included in this study. The results showed no statistically significant differences in the risk of primary outcomes. For the secondary outcomes, there were also no statistically significant differences in the risk of MACEs and major bleeding. However, the pooled results indicated that the hazard ratio (HR) for all-cause mortality with OAC was 0.24 (95% confidence interval (CI) = 0.10–0.55) compared with combination therapy, and the HR for APT compared with OAC was 2.86 (95% CI = 1.48–5.53). Conclusions: In the studied population, OAC or APT alone were proved equally effective for stroke prophylaxis. Furthermore, OAC might reduce the all-cause mortality rate compared with APT and should be considered as the first choice of oral antithrombotic drugs in patients with AFL and CKD.
Highlights
Chronic kidney disease (CKD) is characterized by the abnormal structure or function of the kidney.The prevalence of chronic kidney disease (CKD) stages 1–5 is approximately 11.9% in Taiwan. [1,2] To date, some studies haveMedicina 2020, 56, 266; doi:10.3390/medicina56060266 www.mdpi.com/journal/medicinaMedicina 2020, 56, 266 reported an association between CKD and ischemic stroke. [3,4] Antithrombotic therapies (including antiplatelets (APT) and oral anticoagulants (OAC)) are commonly used in patients with CKD to treat ischemic stroke and systemic embolism of atrial fibrillation (AF) [5]
2468 patients with CKD and atrial flutter (AFL) were identified from the data sources, and 89 patients who were younger than 20 years old at the date of the first AFL episode during the study period as well as those with missing data were excluded
The combination therapy, especially in dual antiplatelet therapy and APT with OAC, was not associated with a lower rate of ischemic stroke or systemic embolism either because the additional protection afforded by APT against thromboembolism was insufficient to overcome this higher intrinsic thrombosis risk or because of some other property of APT that increased the risk of ischemic events during concurrent therapy with an OAC or dual APT
Summary
Chronic kidney disease (CKD) is characterized by the abnormal structure or function of the kidney.The prevalence of CKD stages 1–5 is approximately 11.9% in Taiwan. [1,2] To date, some studies haveMedicina 2020, 56, 266; doi:10.3390/medicina56060266 www.mdpi.com/journal/medicinaMedicina 2020, 56, 266 reported an association between CKD and ischemic stroke. [3,4] Antithrombotic therapies (including antiplatelets (APT) and oral anticoagulants (OAC)) are commonly used in patients with CKD to treat ischemic stroke and systemic embolism of atrial fibrillation (AF) [5]. [3,4] Antithrombotic therapies (including antiplatelets (APT) and oral anticoagulants (OAC)) are commonly used in patients with CKD to treat ischemic stroke and systemic embolism of atrial fibrillation (AF) [5]. No studies have assessed the clinical outcomes in patients with atrial flutter (AFL) and CKD. Some previous studies have shown that the risk of ischemic stroke differs between the two atrial arrhythmias, AF and AFL [6,7]. No relevant studies have assessed the effectiveness and safety of different antithrombotic drugs in chronic kidney disease (CKD) patients with AFL. This cohort study evaluated the effectiveness and safety of different antithrombotic drugs in CKD patients with AFL. Oral antithrombotic therapy (oral anticoagulants (OAC) or antiplatelets (APT)) was administered to patients who had been diagnosed with AFL after being diagnosed with CKD between
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