Stroke and bleeding in atrial fibrillation with chronic kidney disease
Open accessAbstract
BACKGROUND: Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions. METHODS: Using Danish national registries, we identified all patients discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation between 1997 and 2008. The risk of stroke or systemic thromboembolism and bleeding associated with non-end-stage chronic kidney disease and with end-stage chronic kidney disease (i.e., disease requiring renal-replacement therapy) was estimated with the use of time-dependent Cox regression analyses. In addition, the effects of treatment with warfarin, aspirin, or both in patients with chronic kidney disease were compared with the effects in patients with no renal disease. RESULTS: Of 132,372 patients included in the analysis, 3587 (2.7%) had non-end-stage chronic kidney disease and 901 (0.7%) required renal-replacement therapy at the time of inclusion. As compared with patients who did not have renal disease, patients with non-end-stage chronic kidney disease had an increased risk of stroke or systemic thromboembolism (hazard ratio, 1.49; 95% confidence interval [CI], 1.38 to 1.59; P<0.001), as did those requiring renal-replacement therapy (hazard ratio, 1.83; 95% CI, 1.57 to 2.14; P<0.001); this risk was significantly decreased for both groups of patients with warfarin but not with aspirin. The risk of bleeding was also increased among patients who had non-end-stage chronic kidney disease or required renal-replacement therapy and was further increased with warfarin, aspirin, or both. CONCLUSIONS: Chronic kidney disease was associated with an increased risk of stroke or systemic thromboembolism and bleeding among patients with atrial fibrillation. Warfarin treatment was associated with a decreased risk of stroke or systemic thromboembolism among patients with chronic kidney disease, whereas warfarin and aspirin were associated with an increased risk of bleeding. (Funded by the Lundbeck Foundation.).
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CKD is associated with stroke and bleeding in large data sets.
“CKD is associated with stroke and bleeding in large data sets.410, 411”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [410]
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- Authors
- Olesen, J. B., Lip, G. Y. H., Kamper, A.-L., Hommel, K., Køber, L., Lane, D. A., Lindhardsen, J., Gislason, G. H., & Torp-Pedersen, C.
- Affiliations
- Birmingham City Hospital (GB)
- Copenhagen University Hospital (DK)
- Gentofte Hospital (DK)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-08-16
- Volume
- 367
- Issue
- 7
- Pages
- 625-635
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2054077136
- Cited by
- 930
- References
- 28
- Citations by year
- 2026: 26 · 2025: 40 · 2024: 50 · 2023: 42 · 2022: 58 · 2021: 79 · 2020: 70 · 2019: 67 · 2018: 87 · 2017: 76 · 2016: 81 · 2015: 68 · 2014: 92 · 2013: 77 · 2012: 17
- FWCI
- 52.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- Sanofi
- Bayer HealthCare
- Lundbeckfonden
- Astellas Pharma
- Servier
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, chronic kidney disease, stroke, systemic thromboembolism, bleeding risk, warfarin, aspirin, antithrombotic therapy, renal replacement therapy, end-stage renal disease
- MeSH terms
- Aged, Aspirin, Atrial Fibrillation, Female, Hematologic Agents, Hemorrhage, Humans, Kidney Failure, Chronic, Male, Myocardial Infarction, Risk, Thromboembolism, Warfarin, Proportional Hazards Models, Renal Replacement Therapy, Stroke, Renal Insufficiency, Chronic
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