Renal function and the risk of stroke and bleeding in patients with atrial fibrillation

An observational cohort study

A. N. Bonde, Gregory Y H Lip, Anne-Lise Kamper, E L Fosbøl, L. Staerk, Nicholas Carlson, C. Torp-Pedersen, G. Gislason, J. B. Olesen

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Resumé

    Background and Purpose - We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups. Methods - We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR. Results - A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thromboembolism and bleeding. Use of warfarin was associated with higher bleeding risk in all eGFR groups; hazard ratios 1.23 (95% confidence interval [CI], 0.97-1.56), 1.26 (95% CI, 1.14-1.40), 1.18 (95% CI, 1.07-1.31), 1.11 (95% CI, 0.87-1.42), 2.01 (95% CI, 1.14-3.54) in patients with eGFR ≥90, 60 to 89, 30 to 59, 15 to 29, and <15 mL/min per 1.73 m2, respectively. Use of warfarin was associated with lower risk of stroke/thromboembolism in patients with eGFR ≥15 mL/min per 1.73 m2; hazard ratios 0.57 (95% CI, 0.43-0.76), 0.57 (95% CI, 0.51-0.64), 0.48 (95% CI, 0.44-0.54), 0.60 (95% CI, 0.45-0.80) in patients with eGFR ≥90, 60 to 89, 30 to 59, and 15 to 29 mL/min per 1.73 m2, respectively. Use of warfarin was not associated with lower risk of stroke/thromboembolism in patients with eGFR<15 mL/min per 1.73 m2; hazard ratio 1.18 (95% CI, 0.58-2.40). Conclusions - In patients with atrial fibrillation, the risk of stroke and bleeding was associated with levels of renal function. Warfarin treatment was associated with higher risk of bleeding in all eGFR groups and lower risk of stroke in patients with eGFR≥15 mL/min per 1.73 m2. © 2016 American Heart Association, Inc.
    OriginalsprogDansk
    TidsskriftStroke
    Vol/bind47
    Udgave nummer11
    Sider (fra-til)2707-2713
    ISSN0039-2499
    DOI
    StatusUdgivet - 2016

    Citer dette

    Bonde, A. N., Lip, G. Y. H., Kamper, A-L., Fosbøl, E. L., Staerk, L., Carlson, N., ... Olesen, J. B. (2016). Renal function and the risk of stroke and bleeding in patients with atrial fibrillation: An observational cohort study. Stroke, 47(11), 2707-2713. https://doi.org/10.1161/STROKEAHA.116.014422
    Bonde, A. N. ; Lip, Gregory Y H ; Kamper, Anne-Lise ; Fosbøl, E L ; Staerk, L. ; Carlson, Nicholas ; Torp-Pedersen, C. ; Gislason, G. ; Olesen, J. B. / Renal function and the risk of stroke and bleeding in patients with atrial fibrillation : An observational cohort study. I: Stroke. 2016 ; Bind 47, Nr. 11. s. 2707-2713.
    @article{2bb72c88fa8f41679bc97d87da65d01b,
    title = "Renal function and the risk of stroke and bleeding in patients with atrial fibrillation: An observational cohort study",
    abstract = "Background and Purpose - We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups. Methods - We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR. Results - A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thromboembolism and bleeding. Use of warfarin was associated with higher bleeding risk in all eGFR groups; hazard ratios 1.23 (95{\%} confidence interval [CI], 0.97-1.56), 1.26 (95{\%} CI, 1.14-1.40), 1.18 (95{\%} CI, 1.07-1.31), 1.11 (95{\%} CI, 0.87-1.42), 2.01 (95{\%} CI, 1.14-3.54) in patients with eGFR ≥90, 60 to 89, 30 to 59, 15 to 29, and <15 mL/min per 1.73 m2, respectively. Use of warfarin was associated with lower risk of stroke/thromboembolism in patients with eGFR ≥15 mL/min per 1.73 m2; hazard ratios 0.57 (95{\%} CI, 0.43-0.76), 0.57 (95{\%} CI, 0.51-0.64), 0.48 (95{\%} CI, 0.44-0.54), 0.60 (95{\%} CI, 0.45-0.80) in patients with eGFR ≥90, 60 to 89, 30 to 59, and 15 to 29 mL/min per 1.73 m2, respectively. Use of warfarin was not associated with lower risk of stroke/thromboembolism in patients with eGFR<15 mL/min per 1.73 m2; hazard ratio 1.18 (95{\%} CI, 0.58-2.40). Conclusions - In patients with atrial fibrillation, the risk of stroke and bleeding was associated with levels of renal function. Warfarin treatment was associated with higher risk of bleeding in all eGFR groups and lower risk of stroke in patients with eGFR≥15 mL/min per 1.73 m2. {\circledC} 2016 American Heart Association, Inc.",
    author = "Bonde, {A. N.} and Lip, {Gregory Y H} and Anne-Lise Kamper and Fosb{\o}l, {E L} and L. Staerk and Nicholas Carlson and C. Torp-Pedersen and G. Gislason and Olesen, {J. B.}",
    year = "2016",
    doi = "10.1161/STROKEAHA.116.014422",
    language = "Dansk",
    volume = "47",
    pages = "2707--2713",
    journal = "Stroke",
    issn = "0039-2499",
    publisher = "Lippincott Williams & Wilkins",
    number = "11",

    }

    Bonde, AN, Lip, GYH, Kamper, A-L, Fosbøl, EL, Staerk, L, Carlson, N, Torp-Pedersen, C, Gislason, G & Olesen, JB 2016, 'Renal function and the risk of stroke and bleeding in patients with atrial fibrillation: An observational cohort study', Stroke, bind 47, nr. 11, s. 2707-2713. https://doi.org/10.1161/STROKEAHA.116.014422

    Renal function and the risk of stroke and bleeding in patients with atrial fibrillation : An observational cohort study. / Bonde, A. N.; Lip, Gregory Y H; Kamper, Anne-Lise; Fosbøl, E L; Staerk, L.; Carlson, Nicholas; Torp-Pedersen, C.; Gislason, G.; Olesen, J. B.

    I: Stroke, Bind 47, Nr. 11, 2016, s. 2707-2713.

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    TY - JOUR

    T1 - Renal function and the risk of stroke and bleeding in patients with atrial fibrillation

    T2 - An observational cohort study

    AU - Bonde, A. N.

    AU - Lip, Gregory Y H

    AU - Kamper, Anne-Lise

    AU - Fosbøl, E L

    AU - Staerk, L.

    AU - Carlson, Nicholas

    AU - Torp-Pedersen, C.

    AU - Gislason, G.

    AU - Olesen, J. B.

    PY - 2016

    Y1 - 2016

    N2 - Background and Purpose - We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups. Methods - We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR. Results - A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thromboembolism and bleeding. Use of warfarin was associated with higher bleeding risk in all eGFR groups; hazard ratios 1.23 (95% confidence interval [CI], 0.97-1.56), 1.26 (95% CI, 1.14-1.40), 1.18 (95% CI, 1.07-1.31), 1.11 (95% CI, 0.87-1.42), 2.01 (95% CI, 1.14-3.54) in patients with eGFR ≥90, 60 to 89, 30 to 59, 15 to 29, and <15 mL/min per 1.73 m2, respectively. Use of warfarin was associated with lower risk of stroke/thromboembolism in patients with eGFR ≥15 mL/min per 1.73 m2; hazard ratios 0.57 (95% CI, 0.43-0.76), 0.57 (95% CI, 0.51-0.64), 0.48 (95% CI, 0.44-0.54), 0.60 (95% CI, 0.45-0.80) in patients with eGFR ≥90, 60 to 89, 30 to 59, and 15 to 29 mL/min per 1.73 m2, respectively. Use of warfarin was not associated with lower risk of stroke/thromboembolism in patients with eGFR<15 mL/min per 1.73 m2; hazard ratio 1.18 (95% CI, 0.58-2.40). Conclusions - In patients with atrial fibrillation, the risk of stroke and bleeding was associated with levels of renal function. Warfarin treatment was associated with higher risk of bleeding in all eGFR groups and lower risk of stroke in patients with eGFR≥15 mL/min per 1.73 m2. © 2016 American Heart Association, Inc.

    AB - Background and Purpose - We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups. Methods - We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR. Results - A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thromboembolism and bleeding. Use of warfarin was associated with higher bleeding risk in all eGFR groups; hazard ratios 1.23 (95% confidence interval [CI], 0.97-1.56), 1.26 (95% CI, 1.14-1.40), 1.18 (95% CI, 1.07-1.31), 1.11 (95% CI, 0.87-1.42), 2.01 (95% CI, 1.14-3.54) in patients with eGFR ≥90, 60 to 89, 30 to 59, 15 to 29, and <15 mL/min per 1.73 m2, respectively. Use of warfarin was associated with lower risk of stroke/thromboembolism in patients with eGFR ≥15 mL/min per 1.73 m2; hazard ratios 0.57 (95% CI, 0.43-0.76), 0.57 (95% CI, 0.51-0.64), 0.48 (95% CI, 0.44-0.54), 0.60 (95% CI, 0.45-0.80) in patients with eGFR ≥90, 60 to 89, 30 to 59, and 15 to 29 mL/min per 1.73 m2, respectively. Use of warfarin was not associated with lower risk of stroke/thromboembolism in patients with eGFR<15 mL/min per 1.73 m2; hazard ratio 1.18 (95% CI, 0.58-2.40). Conclusions - In patients with atrial fibrillation, the risk of stroke and bleeding was associated with levels of renal function. Warfarin treatment was associated with higher risk of bleeding in all eGFR groups and lower risk of stroke in patients with eGFR≥15 mL/min per 1.73 m2. © 2016 American Heart Association, Inc.

    U2 - 10.1161/STROKEAHA.116.014422

    DO - 10.1161/STROKEAHA.116.014422

    M3 - Tidsskriftartikel

    VL - 47

    SP - 2707

    EP - 2713

    JO - Stroke

    JF - Stroke

    SN - 0039-2499

    IS - 11

    ER -