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Thromb Haemost 2018; 118(02): 279-287
DOI: 10.1160/TH17-06-0416
Coagulation and Fibrinolysis
Schattauer GmbH Stuttgart

Relation of Renal Dysfunction to Quality of Anticoagulation Control in Patients with Atrial Fibrillation: The FANTASIIA Registry

María Asunción Esteve-Pastor
,
José Miguel Rivera-Caravaca
,
Inmaculada Roldán-Rabadán
,
Vanessa Roldán
,
Javier Muñiz
,
Paula Raña-Míguez
,
Martín Ruiz-Ortiz
,
Ángel Cequier
,
Vicente Bertomeu-Martínez
,
Lina Badimón
,
Manuel Anguita
,
Gregory Y. H. Lip   *
,
Francisco Marín   *
,
on behalf of FANTASIIA Study Investigators
Funding The FANTASIIA registry was funded by an unconditional grant from Pfizer/Bristol-Myers-Squibb and by grants from the Instituto de Salud Carlos III (Madrid)-FEDER (RD12/0042/0068, RD12/0042/0010, RD12/0042/0069 and RD12/0042/0063).The authors are supported by RD12/0042/0049 (RETICS) from ISCIII and PI13/00513/FEDER from ISCIII. Fundación Séneca (19245/PI/14), Instituto Murciano de Investigación Biosanitaria (IMIB16/AP/01/06). José Miguel Rivera-Caravaca has received a grant from Sociedad Española de Trombosis y Hemostasia (SETH; grant for short international training stays 2016).
Further Information

Publication History

16 June 2017

02 November 2017

Publication Date:
29 January 2018 (online)

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Abstract

Background One-third of atrial fibrillation (AF) patients have chronic kidney disease (CKD), a condition that itself increases thromboembolic and major bleeding risks, especially in patients with severe CKD. Bleeding would be accentuated by suboptimal anticoagulation control with vitamin K antagonists (VKA).

Purpose This article aimed to investigate the incidence of cardiovascular events, mortality and quality of anticoagulation in relation to CKD in a ‘real-world’ prospective cohort of AF patients included in the FANTASIIA registry.

Methods We analysed consecutive AF patients who were prospectively recruited with a year of follow-up. The quality of anticoagulation was estimated by time in therapeutic range (TTR). The annual incidence of events was analysed.

Results We studied 1,936 patients (male: 55.7%, mean: 73.8 ± 9.4 years): 445 (22.9%) had normal function, 698 (36.1%) had mild CKD, 713 (36.8%) had moderate CKD and 80 (4.2%) had severe CKD. Patients with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (severe CKD) had lower TTR (53.3 ± 25.6% vs. 61.8 ± 25.1%, p = 0.007) and higher proportion of poor TTR (67.2 vs. 51.8%; p = 0.014) than patients with eGFR ≥30 mL/min/1.73 m2. Severe CKD was significantly associated with cardiovascular mortality (hazard ratio [HR]: 9.33; p = 0.002), major bleeding (HR: 2.94; p = 0.036) and major adverse cardiovascular events (MACE) (HR: 4.93; p = 0.004). Importantly, 375 patients (21.1%) showed a deteriorating eGFR of ≥10 mL/min during the follow-up, with significantly higher mortality and cardiovascular events.

Conclusion In a prospective and real-world AF registry, approximately 67% of patients with severe CKD had poor anticoagulation control while taking VKA. The presence of severe CKD was an independent factor for cardiovascular mortality, MACE and major bleeding. Worsening eGFR of only ≥10 mL/min during follow-up was significantly associated with mortality and major bleeding.

Keywords

chronic kidney disease - renal function - atrial fibrillation - vitamin K antagonists - time in therapeutic range - acenocoumarol

* Joint senior authors.


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