Oral anticoagulant therapy and decline of kidney function in elderly patients with non-valve atrial fibrillation: real world evidence data

Abstract Background Non Valvular Atrial fibrillation (NVAF) is an independent predictor of cardiovascular (CV) mortality and morbidity. The incidence prevalence increase in proportion to age comorbidity burden especially elderly patients whom oral anticoagulant therapy (OAT) difficult manage, it often underused for limitations efficacy safety presented by vitamin K antagonists (AVK). Direct coagulation inhibitors (DOACs) are as effective AVKs with a better profile, ensuring lower major bleeding. NVAF Chronic Kidney Disease (CKD) mutually connected coexist the patient. AF risk factor progression CKD, decrease renal function, CKD also increases bleeding thromboembolism, making stratification treatment difficult. All available DOACs partially eliminated kidneys therefore, function inevitably influences our therapeutic strategies. Purpose aim this work evaluate any differences between AVK versus patient's on decline population important comorbidities. Methods We enrolled 411 Caucasian aged ≥70 years, affected comorbidities; 135 receiving VKA 276 DOACs, median was 77.2 years (IQR 72.7–81.6). Patients underwent clinical-instrumental laboratory evaluation follow-up 6.9±2.5 years. severe hepatic impairment or ClCr <15 mL/min were excluded from study. Rapid defined annual loss ≥5 mL/min/1.73 m2 estimated events/year. Data expressed mean standard deviation interquartile range (IQR) when appropriate. Results During average there statistically significantly NOAC eGFR (p<0.001), glycaemia (p<0.0001), systolic blood pressure (SBP) haemoglobin (HB) number events/year (35/135 (25.9) vs 36/276 (13.0), p=0.001). In group, linear correlation analysis performed different covariates Δ variation baseline follow-up. ΔeGFR correlated diastolic (ΔDBP), ΔSBD, ΔBMI ΔHb. From stepwise model, ΔHb ΔeGFr, justifying 18.0% its variation. Conclusion present study confirms profile compared multimorbid population, even though had greater comorbidities that negatively affect such arterial hypertension, COPD, heart failure; at value than group. Funding Acknowledgement Type funding sources: None.