P4020Use of novel oral anticoagulants in patients with atrial fibrillation and moderate to severe renal dysfunction: findings from a prospective national registry

Abstract

Background: Patients with advanced renal dysfunction were mostly excluded from clinical trials that evaluated the benefit of novel oral anticoagulants (NOACs) in patients with atrial fibrillation. Purpose: We aimed to prospectively evaluate the clinical characteristics and outcomes of patients with atrial fibrillation (AF) and chronic kidney disease (CKD) who receive apixaban vs. warfarin therapy, with a focus on dosing adjustments their association with outcomes. Methods: Hospitalized AF patients with eGFR <60 ml/min were recruited to a prospective national registry involving 18 cardiology, internal medicine, and geriatric departments in Israel. Between April 2014 to January 2016 we enrolled 2000 patients who received apixaban (n=1000) or warfarin (n=1000) during the index hospitalization. Primary outcomes included death, stroke, systemic embolism (SE), and major bleeding at 1‐year. Results: Mean age of study patients was 76±10 years, 35% were women, 27% of the study population had advanced renal dysfunction (eGFR <30 mil/min). Multivariate model showed that patients who were prescribed apixaban vs. warfarin displayed a higher risk profile, including older age (OR=1.9 [p