Oral Anticoagulants Are Underused Among Patients With AFib and Advanced CKD

Individuals with atrial fibrillation (AFib) who have advanced chronic kidney disease are more likely to use aspirin than oral anticoagulants, according to new research presented at the American College of Cardiology’s Annual Scientific Session & Expo 2019.

To analyze how oral anticoagulant prescribing patterns and clinical outcomes change based on a patient’s chronic kidney disease status, lead author Michael Dorsch, MS, PharmD, and colleagues evaluated data on participants from the Premier Health Database. In all, 370,672 admissions from across 797 US hospitals were included in the study.

The selected participants, aged 40 or older, had been admitted from January 2011 to June 2015 with an AFib diagnosis, had a CHA2DS2-VASc score of 2 or more, had stayed in the hospital for more than 1 day, and had stage 1 or higher chronic kidney disease.

The participants were classified into 2 groups: those with chronic kidney disease of stage 1 to 3 and those with stage 4 to end-stage. 

Oral anticoagulants were used by 45% of the participants, but the medications’ use was strongly associated with the participants’ chronic kidney disease status. The more advanced a participant’s kidney disease was, the less likely he or she was to be on an oral anticoagulant. In fact, while 49.1% of those with stage 1 chronic kidney disease used oral anticoagulants, 36.4% of their counterparts with end-stage did the same. 

According to the researchers, this drop off in oral anticoagulant use can probably be attributed to the facts that there was a decrease in direct oral anticoagulant (DOAC) use (18.7% vs 2.2%) and an increase in aspirin use (17.7% vs 25.1%) as chronic kidney disease advanced.

“Chronic kidney disease status was associated with differential effects on bleeding, with DOAC therapy having lower 1-year bleeding compared to warfarin in CKD stage IV to end stage,” the researchers concluded. “DOAC consistently reduced 1-year mortality compared to warfarin.” —Colleen Murphy