Uncertainty over anticoagulation risks and benefits in CKD patients with AF
There is an urgent need for randomised controlled trials investigating the risks of anticoagulation in patients with chronic kidney disease and atrial fibrillation.
The risk of both stroke and haemorrhage increases as chronic kidney disease (CKD) progresses, which can complicate the decision on whether to begin anticoagulation in those with concomitant atrial fibrillation (AF).
In the BMJ (14 February 2018), researchers studied general practice data on 2,434 matched pairs of CKD patients aged 65 years and over who were newly diagnosed with AF. One patient in each pair was prescribed anticoagulation within 60 days of diagnosis.
After a median follow-up of 506 days, researchers found that rates of both stroke and haemorrhage were higher in patients who received anticoagulation (hazard ratio [HR] 2.60 and 2.42, respectively). However, these patients had a reduced risk of death from all causes (HR 0.82) compared with those who did not receive anticoagulation.
The researchers said the paradoxical findings indicate an urgent need for randomised trials to inform guidance on anticoagulation in this population.
Citation: Clinical Pharmacist DOI: 10.1211/CP.2018.20204581
Recommended from Pharmaceutical Press
Pharmacy Registration Assessment Questions features over 400 closed book and calculation questions. With the registration exam having gone through a complete transformation in 2016, this volume has been developed around the new General Pharmaceutical Council (GPhC) guidelines.£33.00Buy now