Adverse Clinical Outcomes and Associated Predictors in Rivaroxaban-Treated Atrial Fibrillation Patients With Renal Impairment.

Autor: Rivera-Caravaca JM; Faculty of Nursing, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain., Anguita Sanchez M; Cardiology Department, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica (IMIBIC), Córdoba, Spain., Sanmartín Fernández M; Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Rafols C; Medical Affairs Department, Bayer Hispania SL, Barcelona, Spain., Barón-Esquivias G; Cardiology and Cardiac Surgery Department, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain., Arribas Ynsaurriaga F; Cardiology Department, Hospital Universitario l de Octubre, Universidad Complutense, CIBERCV, Madrid, Spain., Freixa-Pamias R; Cardiology Department, Complex Hospitalari Moisès Broggi, Barcelona, Spain., Lekuona Goya I; Cardiology Department, Hospital Universitario de Galdakao, Vizcaya, Spain., Vázquez Rodríguez JM; Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, CIBERCV, A Coruña, Spain., Pérez-Cabeza AI; Cardiology Department, Hospital Clínico Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain., Cosín-Sales J; Cardiology Department, Hospital Arnau de Vilanova, Valencia, Spain., Ureña Montilla I; Cardiology Department, Hospital Universitario Morales Meseguer, Murcia, Spain., Álvarez-Vieitez Blanco A; Cardiology Service, Hospital Nuestra Señora del Rosario, Madrid, Spain., Marín F; Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain. Electronic address: fr.marino@um.es.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2023 Sep 15; Vol. 203, pp. 122-127. Date of Electronic Publication: 2023 Jul 22.
DOI: 10.1016/j.amjcard.2023.06.105
Abstrakt: Renal impairment confers worse prognosis in patients with atrial fibrillation (AF) but there is scarce evidence about the influence of direct-acting oral anticoagulants in routine clinical practice. Herein, we compared clinical outcomes between patients with AF with and without renal impairment on rivaroxaban and investigated predictors for clinical outcomes in patients with AF with renal impairment. This was a multicenter study including patients with AF on rivaroxaban for at least 6 months. During 2.5 years follow-up, ischemic strokes (IS)/transient ischemic attacks (TIA)/systemic embolisms (SE)/myocardial infarctions (MI), major bleeding, and major adverse cardiovascular events (MACE) were recorded. Creatinine clearance (CrCl) was estimated using the Cockroft-Gault equation, renal impairment was defined as a CrCl <60 ml/min, and 1,433 patients (34.8% with CrCl <60 ml/min) were included. Patients with CrCl <60 ml/min showed higher event rates for major bleeding (1.87%/year vs 0.62%/year; p = 0.003) and MACE (1.97%/year vs 0.62%/year; p = 0.002) but similar event rates for IS/TIA/SE/MI (0.66%/year vs 0.67%/year; p = 0.955). In patients with renal impairment, CHA 2 DS 2 -VASc was associated with higher risk of IS/TIA/SE/MI; HAS-BLED and any dependency level were associated with higher risk of major bleeding; and male gender and heart failure were associated with higher risk of MACE. Antiplatelets were independently associated with increased risk of IS/TIA/SE/MI and MACE. In conclusion, in patients with AF on rivaroxaban, the incidence of IS/TIA/SE/MI did not increase in those with renal impairment, suggesting that rivaroxaban may be an effective option in this subgroup. In patients with AF, male gender, heart failure, dependency, antiplatelets, CHA 2 DS 2 -VASc, and HAS-BLED were associated with increased risk of adverse outcomes.
Competing Interests: Declaration of Competing Interest JM Rivera-Caravaca is a consultant for Idorsia Pharmaceuticals LTD. M. Anguita Sanchez has received financial compensation from Bayer for participating in the EMIR registry. M. Sanmartín Fernández has received speaker and advisory fees from the following companies in the past 3 years: Bayer, Boehringer-Ingelheim, BMS, and Pfizer. C. Rafols is an employee of the Medical Department, Bayer Hispania S.L, which is the sponsor of the EMIR study. G. Barón-Esquivias has received lecture fees from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, Pfizer-BMS, Sanofi, Novartis, and Rovi; and financial compensation from Bayer for participating in the EMIR study and an institutional grant from Novartis. J. Cosín-Sales has received financial compensation from Bayer for participating in the EMIR registry. R. Freixa-Pamias has received consultancy/lecturing fees from Bayer, BMS/Pfizer, Boehringer-Ingelheim, and Daiichi Sankyo; and financial compensation from Bayer for participating in the EMIR study. I. Lekuona Goya has received financial compensation from Bayer for participating in the EMIR study. JM Vázquez Rodríguez has received lecture fees from Bayer, Boehringer-Ingelheim, Pfizer, Bristol Myers Squibb, and Daiichi Sankyo; and financial compensation from Bayer for participating in the EMIR study. AI Pérez-Cabeza has received consultancy/lecturing fees from Bayer, Boehringer-Ingelheim, Pfizer, Bristol Myers Squibb, and Daiichi Sankyo. I. Ureña Montilla has received financial compensation from Bayer for participating in The EMIR study; speaker and advisory fees from the following companies: Bayer, Novartis, Daiichi Sankyo, Vifor, Boehringer-Ingelheim, and Amgen. A. Alvarez-Vieitez Blanco has received financial compensation from Bayer for participating in the EMIR study. F. Arribas Ynsaurriaga has received consultancy/lecture fees and research funding from Daiichi Sankyo, Pulse Dynamics, Medtronic, Boston Scientific, Bayer, Bristol Myers Squibb, Arrhythmia Network Technology SL/BAROSTIM, Abbott, Novartis, Janssen-Cilag, Biosensors, and Edwards Lifesciences; and received financial compensation from Bayer for participating in the EMIR registry. F Marín has received consultancy/lecturing fees from Bayer, Boehringer-Ingelheim, Pfizer, Bristol Myers Squibb, and Daiichi Sankyo.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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