Anticoagulants for Patients with Afib and Kidney Disease? Study Yields Mixed Findings

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Older adults with chronic kidney disease (CKD) who begin anticoagulants for atrial fibrillation (AF) face increased risk for stroke — but decreased risk for all-cause mortality — according to a retrospective study in The BMJ.

Using a U.K. primary care database, researchers matched 2400 older adults with CKD and newly diagnosed AF who received an anticoagulant prescription within 60 days of AF diagnosis to a similar cohort who didn't receive anticoagulants. Warfarin was the most commonly prescribed anticoagulant (72%), followed by rivaroxaban and apixaban.

During roughly 17 months' follow-up, ischemic stroke occurred in 6.4% of all patients, and hemorrhage in 1.6%. Additionally, 29% of patients died. After multivariable adjustment, receipt of anticoagulation was associated with over a twofold increase in risk for stroke or hemorrhage — but also an 18% decrease in mortality risk.