Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF.



van der Wall, Sake J, Teutsch, Christine, Dubner, Sergio J, Diener, Hans-Christoph, Halperin, Jonathan L, Ma, Chang Sheng, Rothman, Kenneth J, Paquette, Miney, Zint, Kristina, França, Lionel Riou
et al (show 4 more authors) (2021) Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF. TH open : companion journal to thrombosis and haemostasis, 5 (1). e35 - e42.

Access the full-text of this item by clicking on the Open Access link.

Abstract

<b>Objective</b>  Anticoagulation management in patients with atrial fibrillation (AF) and impaired renal function is challenging. This study aimed to evaluate anticoagulation prescription patterns in relation to renal function and to describe 2-year clinical outcomes among dabigatran users. <b>Methods</b>  Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international, prospective, and observational study program involving patients with newly diagnosed AF at risk for stroke. Prescription patterns were assessed by creatinine clearance (CrCl) at enrollment. Dabigatran users were followed for 2 years. Clinical outcomes were standardized for stroke and bleeding risk, based on CHA <sub>2</sub> DS <sub>2</sub> -VASc and HAS-BLED scores, with missing values imputed. <b>Results</b>  Baseline CrCl values were available for 12,056 of 15,308 eligible patients (79%). With declining renal function, prescriptions increased for vitamin K antagonists (VKAs) and decreased for dabigatran (30-47% and 34-12%, respectively). The prescription of other non-vitamin K antagonists remained similar across CrCl groups (14-19%). In 4,873 dabigatran users, standardized stroke rates were low across all CrCl groups; 0.58/100 patient-years (95% confidence interval [CI]: 0.30-0.90) in CrCl ≥80 mL/min, 0.85 (95% CI: 0.48-1.21) in CrCl 50 to 79 mL/min, and 0.33 (95% CI: 0.06-1.11) in CrCl 30 to 49 mL/min. Similarly, major bleeding rates were low and numerically increased with declining renal function (0.68/100 patient-years, 95% CI: 0.39-1.03; 0.92, 95% CI: 0.58-1.32; and 1.26, 95% CI: 0.66-1.97, respectively). <b>Conclusion</b>  In patients with AF, VKA prescriptions increased and dabigatran prescriptions decreased with declining renal function. Rates of stroke and major bleeding in dabigatran patients remained low across the categories of renal impairment.

Item Type: Article
Uncontrolled Keywords: GLORIA-AF Investigators
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 22 Jun 2021 09:49
Last Modified: 14 May 2022 07:19
DOI: 10.1055/s-0040-1722706
Open Access URL: http://doi.org/10.1055/s-0040-1722706
URI: https://livrepository.liverpool.ac.uk/id/eprint/3127281