MO184ANTICOAGULANT THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION

Abstract

Abstract Background and Aims Chronic kidney disease (CKD) significantly alters the pharmacokinetics of drugs, which in practice complicates the selection of adequate anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and CKD. At the same time, in the vast majority of patients with AF and CKD, ACT is required to prevent life-threatening thromboembolic complications. In such an environment, maintaining a balance between the effectiveness and safety of ACTs is extremely important. Aim is evaluation of the efficacy and safety of the use of direct oral anticoagulants (OAC) in CKD stages 1-3 in combination with AF. Method The study included 93 patients (38 men and 55 women) aged 41 to 86 years with CKD stages 1-3 and AF receiving therapy with OAC (rivaroxaban) and vitamin K antagonists (warfarin). The observation period was 12 months. Results An analysis of 75 patients with CKD of various stages and AF receiving rivaroxaban was performed, the control group consisted of 18 patients taking warfarin. The average CHA2 DS2-VASc score in the OAC group was 4.1±1.8 points, in the warfarin group - 4.2±1.3 points. There were also no significant differences between the groups in terms of the average score on the HAS-BLED scale (risk of developing hemorrhagic complications): 2.3±0.94 points in the OAC group, 2.5±0.6 points in the warfarin group. Among the comorbidities in the OAC group, 93.2% of patients had arterial hypertension (AH), 24.5% had type 2 diabetes mellitus (DM); in the warfarin group, 94.3% of patients had hypertension and 16.8% had type 2 diabetes. In 23.9% of patients in the OAC group, minor bleeding was recorded. The largest number of hemorrhagic complications occurred in patients with stage 3 CKD: 18.9% of bleeding, which significantly (p<0.05) exceeds the number of bleeding in patients with a more pronounced decrease in renal function. In 33.3% of patients with diabetes, hemorrhagic complications were recorded, which is significantly (p<0.05) more than in the group of patients without diabetes - 21.4%. The greater number of hemorrhagic complications is most likely due to a more pronounced progression of the decline in renal function compared with patients without diabetes: 71.4% of patients with diabetes showed a decrease in GFR by an average of 16.6 ml/min/1.73 m2 for 12 months, which is significantly more (p<0.05) than in patients without diabetes (an average of 5.7 ml/min/1.73 m2). Conclusion In patients with CKD stages 1-3 with non-valvular AF, the use of OAC is most effective and safe in preventing thromboembolic complications. At the same time, the progression of CKD against the background of diabetes when taking anticoagulants occurs faster than in its absence, regardless of the specific anticoagulant. Patients with AF, DM and CKD are more likely to have hemorrhagic complications, which requires more frequent monitoring and monitoring of the functional state of the kidneys.