Risk of Bleeding, Thrombosis and Death among Atrial Fibrillation Patients Treated with Oral Anticoagulants Across Estimated Glomerular Filtration Rates

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There are limited data about clinical benefts and harm of oral anticoagulants (OACs) for stroke prevention in patients with atrial fbrillation (AF) and chronic kidney disease (CKD) by using CKD-EPI creatinine equation for glomerular filtration rate (GFR) estimation in nuanced GFR stratification. We conducted a retrospective study in 12 centers in China, included 9510 AF patients. We grouped patients into following eGFR categories:≥60(n=7616), 45-59(n=1139), 30-44(n=474), and <30(n=281) mL/min/1.73m2. Logistic regression was used to compare risks of major bleeding, minor bleeding, total bleeding, thrombosis and all-cause deaths in AF patients between eGFR 45-59, 30-44, <30 mL/min/1.73m2 and ≥60 mL/min/1.73 m2 after taking OACs. AF patients treated with OACs with eGFR 45-59, 30-44 and <30 ml/min/1.73 m2 significantly elevated risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m2 (aOR: 1.326, 95% CI: 1.049-1.665, P=0.016; aOR: 1.634, 95% CI: 1.197-2.200, P=0.002; aOR: 2.492, 95% CI: 1.766-3.471, P<0.001;). Higher eGFR was associated with a significantly lower risk of all-cause deaths (aOR: 0.990, 95% CI: 0.986-0.994, P<0.001) and major bleeding (aOR: 0.988, 95% CI: 0.979-0.998, P=0.018). DOACs remarkably reduced risk of major bleeding in eGFR 30-44 ml/min/1.73 m2 compared with warfarin. In conclusion, in AF patients treated with OACs, patients with eGFR 45-59, 30-44 and <30 ml/min/1.73 m2 significantly elevated risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m2, and the risk of all-cause deaths increased with decreasing eGFR. DOACs are at least safe alternatives to warfarin in AF patients with eGFR 30-44ml/min/ 1.73 m2.