MO182: Safety Analysis of Anticoagulant Therapy in Stage 4 CKD in Combination with AF

Abstract

Abstract BACKGROUND AND AIMS A renocardial comorbid condition with a combination of chronic kidney disease (CKD) and atrial fibrillation (AF) increases the risk of thromboembolic complications (TEC) and hemorrhagic events. As kidney function worsens, this risk only increases. Anticoagulant therapy is the standard for prevention of acute cerebrovascular accident (ACVA) in AF. Clinical data on the use of new oral anticoagulants (NOACs) in patients with advanced CKD and AF are very limited, which indicates the relevance of research. Analysis of safety and efficacy indicators of rivaroxaban in patients with stage 4 CKD in combination with AF. METHOD The study included 106 patients with a glomerular filtration rate (GFR) of 15–29 mL/min/1.73 m2 and AF. A total of 73 patients took rivaroxaban at a dose of 15 mg/day and 33 patients took warfarin, the dose of which was individually adjusted according to INR values. The average follow-up period was 18 months. Thromboembolic complications were the primary endpoint. The secondary endpoint is the development of haemorrhagic events (major and minor bleeding). RESULTS In the rivaroxaban group, the mean CHA2DS2 VASc score was 4.9, the HAS BLED score was 3.2, and in the warfarin group, 4.5 and 3.1, respectively. The incidence of stroke in the rivaroxaban group was observed in one patient (1.37%), and in the warfarin group in two patients (6.06%). The results of the study on the primary endpoint indicate that the indicators in both groups did not differ significantly (P = .24). The incidence of haemorrhagic events such as minor bleeding in the rivaroxaban group on the BARC scale was n = 31 (42.5%), and n = 24 (72.7%) in the warfarin group (P < .01). This indicator on the ISTH scale is n = 27 (36.9%) and n = 21 (63.6%), respectively. Major bleeding was observed in the rivaroxaban group n = 2 (2.74%), and in the warfarin group n = 2 (6.06%) on the BARC and ISTH scales (P = .31). Heamorrhagic events were significantly more frequent in the warfarin group compared with the rivaroxaban group. CONCLUSION The data obtained from this study indicate a favourable safety profile of NOAC (rivaroxaban) compared with a vitamin K antagonist in patients with stage 4 CKD in combination with AF.