Joel M. Gore, MD reviewing Bonde AN et al. Stroke 2016 Nov.
Findings from an observational study suggest that risks for both thromboembolic and bleeding outcomes rise with increasing levels of renal dysfunction.
Balancing the benefit of stroke prevention and the risk for bleeding with anticoagulation is uniquely challenging in patients with atrial fibrillation (AF) and renal dysfunction. To explore the relationship between renal function and AF outcomes, investigators conducted a registry-based cohort study involving 17,349 adults (median age, 73; 53% women) with nonvalvular AF discharged from Danish hospitals between 1997 and 2011. Participants were divided into glomerular filtration rate (GFR) quintiles of ≥90, 60–89, 30–59, 15–29, and <15 mL/min per 1.73 m2.
Median follow-up ranged from 0.5 years (in the lowest GFR quintile) to 4.9 years (in the second-highest GFR quintile). Cumulative incidence of both stroke/thromboembolism and major bleeding increased with decreasing GFR levels. Lower GFR was also associated with an incremental increase in risk for both outcomes compared with GFRs in the highest quintile.
Patients in the second-highest and lowest quintiles were most and least likely, respectively, to receive warfarin. In patients with a GFR ≥15 mL/min per 1.73 m2, rates of stroke/thromboembolism were lower and rates of major bleeding were higher in warfarin recipients than in nonrecipients. In patients with a GFR <15 mL/min per 1.73 m2, rates of stroke/thromboembolism were comparable in warfarin recipients and nonrecipients, but bleeding rates were higher in warfarin recipients than in nonrecipients. Warfarin treatment was associated with reduced risk for stroke in all patients except those in the lowest GFR quintile and with increased risk for bleeding across all levels of GFR, although the increase was nonsignificant in patients in the highest and second-lowest quintiles.
CITATION(S):
Bonde AN et al. Renal function and the risk of stroke and bleeding in patients with atrial fibrillation: An observational cohort study. Stroke 2016 Nov; 47:2707.
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