open access

Vol 79, No 10 (2021)
Original article
Published online: 2021-08-09
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Thromboembolism and bleeding in patients with atrial fibrillation and stage 4 chronic kidney disease: impact of biomarkers

Paweł T Matusik12, Wiktor J Leśniak3, Zbigniew Heleniak4, Anetta Undas25
DOI: 10.33963/KP.a2021.0088
·
Pubmed: 34392517
·
Kardiol Pol 2021;79(10):1086-1092.
Affiliations
  1. Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Experimental Cardiac Surgery, Anesthesiology and Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  3. Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  4. Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
  5. Krakow Centre for Medical Research and Technologies, The John Paul II Hospital, Kraków, Poland

open access

Vol 79, No 10 (2021)
Original article
Published online: 2021-08-09

Abstract

Background: Chronic kidney disease (CKD) is considered a risk factor for thromboembolic and bleeding events in patients with atrial fibrillation (AF).
Aims: We sought to assess predictors of clinical outcomes among AF patients with advanced CKD.
Methods: In a prospective cohort study, we enrolled 180 AF patients with stage 4 CKD, defined as estimated glomerular filtration rate of 15–29 ml/min/1.73 m2, on vitamin K antagonists (n = 90), and non-vitamin K antagonists oral anticoagulants (n = 90). We assessed biomarkers, including growth differentiation factor-15, cystatin C, and high-sensitivity cardiac troponin T, and prothrombotic state parameters, including plasma fibrin clot permeability (Ks).
Results: The median age of the patients was 71.0 (64.0–75.0) years (men 65.0%). The median estimated glomerular filtration rate was 24.0 (21.0–25.0) ml/min/1.73 m2 while the median CHA2DS2-VASc score was 3.0 (2.0–4.0). Age (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.02–1.20) and decreased Ks (HR, 0.55; 95% CI, 0.34–0.90) were associated with thromboembolic events (n = 18; 4.7% per year). Previous bleeding (HR, 3.21; 95% CI, 1.22–8.45), growth differentiation factor-15 (HR, 1.48; 95% CI, 1.29–1.69), cystatin C (HR, 9.24; 95% CI, 2.15–39.67), and high-sensitivity cardiac troponin T (HR, 1.30; 95% CI, 1.14–1.48) were independent predictors of major or clinically relevant non-major bleeding (n = 27; 7.1% per year). After adjustment for age and comorbidities, only cystatin C (HR, 3.95; 95% CI, 1.08–14.37) predicted mortality (n = 25; 6.5% per year).
Conclusions: Novel biomarkers might be useful in risk stratification of thromboembolic and bleeding events in AF patients with stage 4 CKD receiving oral anticoagulants.

Abstract

Background: Chronic kidney disease (CKD) is considered a risk factor for thromboembolic and bleeding events in patients with atrial fibrillation (AF).
Aims: We sought to assess predictors of clinical outcomes among AF patients with advanced CKD.
Methods: In a prospective cohort study, we enrolled 180 AF patients with stage 4 CKD, defined as estimated glomerular filtration rate of 15–29 ml/min/1.73 m2, on vitamin K antagonists (n = 90), and non-vitamin K antagonists oral anticoagulants (n = 90). We assessed biomarkers, including growth differentiation factor-15, cystatin C, and high-sensitivity cardiac troponin T, and prothrombotic state parameters, including plasma fibrin clot permeability (Ks).
Results: The median age of the patients was 71.0 (64.0–75.0) years (men 65.0%). The median estimated glomerular filtration rate was 24.0 (21.0–25.0) ml/min/1.73 m2 while the median CHA2DS2-VASc score was 3.0 (2.0–4.0). Age (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.02–1.20) and decreased Ks (HR, 0.55; 95% CI, 0.34–0.90) were associated with thromboembolic events (n = 18; 4.7% per year). Previous bleeding (HR, 3.21; 95% CI, 1.22–8.45), growth differentiation factor-15 (HR, 1.48; 95% CI, 1.29–1.69), cystatin C (HR, 9.24; 95% CI, 2.15–39.67), and high-sensitivity cardiac troponin T (HR, 1.30; 95% CI, 1.14–1.48) were independent predictors of major or clinically relevant non-major bleeding (n = 27; 7.1% per year). After adjustment for age and comorbidities, only cystatin C (HR, 3.95; 95% CI, 1.08–14.37) predicted mortality (n = 25; 6.5% per year).
Conclusions: Novel biomarkers might be useful in risk stratification of thromboembolic and bleeding events in AF patients with stage 4 CKD receiving oral anticoagulants.

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Keywords

atrial fibrillation, biomarkers, bleeding, chronic kidney disease, stroke

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About this article
Title

Thromboembolism and bleeding in patients with atrial fibrillation and stage 4 chronic kidney disease: impact of biomarkers

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 79, No 10 (2021)

Article type

Original article

Pages

1086-1092

Published online

2021-08-09

DOI

10.33963/KP.a2021.0088

Pubmed

34392517

Bibliographic record

Kardiol Pol 2021;79(10):1086-1092.

Keywords

atrial fibrillation
biomarkers
bleeding
chronic kidney disease
stroke

Authors

Paweł T Matusik
Wiktor J Leśniak
Zbigniew Heleniak
Anetta Undas

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