SaO021ISCHAEMIC STROKE, HAEMORRHAGE, AND MORTALITY IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASE NEWLY STARTED ON ANTI-COAGULATION FOR ATRIAL FIBRILLATION - A POPULATION BASED STUDY FROM UK PRIMARY CARE

Abstract

Introduction and Aims: Significant uncertainty exists around whether to anti-coagulate patients with CKD and atrial fibrillation. Our study was designed to assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all-cause mortality, in older people with atrial fibrillation (AF) and chronic kidney disease (CKD). Method(s): This was a propensity-matched population-based retrospective cohort analysis from January 2006 through December 2016 using The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database population of almost 2.73 million patients from 110 General Practices across England and Wales. Patients aged 65 years and over with a new diagnosis of AF and estimated glo-merular filtration rate (eGFR) of <50 ml/min/1.73m2, calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) creatinine equation. Patients with a previous diagnosis of AF or receiving anticoagulation in the preceding 120 days, were excluded, along with dialysis-requiring patients and renal transplant recipients. Result(s): We identified 6,977 patients with CKD and newly diagnosed AF, of whom 2,434 were anticoagulated within 60 days of diagnosis and 4,543 were not. We matched 2,434 pairs using propensity scores by exposure to anticoagulant or not and followed for a median of 506 days. The crude rates for ischaemic stroke and haemorrhage were 4.6 and 1.2 following anticoagulation, and 1.5 and 0.4 in non-anticoagulated patients per 100-person years, respectively. The hazard ratios for ischaemic stroke, haemorrhage and all-cause mortality for those anticoagulated were 2.60 (95% confidence interval, 2.00-3.38), 2.42 (1.44-4.05) and 0.82 (0.74-0.91) when compared to those who received no anticoagulation. Conclusion(s): This is the largest study report in the current literature of this important and clinically challenging area. Anticoagulating older people with concomitant AF and CKD was associated with an increased rate of ischaemic stroke and haemorrhage (see Figure below) but a paradoxically lowered rate of all-cause mortality. Careful con-sideration should be given before initiating anticoagulation in older people with CKD developing AF. There remains a very urgent need for adequately powered randomised trials in this population further to explore these findings and to provide clarity on the correct clinical management.