19 February 2018

Doctors should be cautious about prescribing anticoagulants to patients with atrial fibrillation when they also have chronic kidney disease (CKD), British researchers have warned.

A population-based study has found a significantly increased risk of ischaemic stroke and haemorrhage associated with administration of the medication among this group.

However, these patients also experienced a slightly reduced mortality level from taking the drugs, according to the research published in The BMJ.

The researchers based at University of Surrey, St George’s and University College London, studied GP records to find nearly 5,000 patients with CKD and newly-diagnosed atrial fibrillation. Half the patients received anticoagulants and half did not.

Over a period of 500 days, those on anticoagulants faced a doubled risk of stroke and haemorrhage.

Researcher Dr Shankar Kumar, of University College London, said the findings highlighted the “complexity” of treating these patients and called for randomised control trials.

Dr Kumar said: “We found that in this particular group, their medication seems to do the opposite of its intended effect.

“As we found a paradoxical reduced mortality rate alongside increased rates of stroke and major bleeding, this is clearly a very complex area.”

Fellow researcher Professor John Camm, of St George’s, said: “People with chronic kidney disease tend to have numerous severe complications, including cardiovascular illnesses.

“As their blood clots more but they also bleed more easily, it is extremely difficult to strike a balance between different treatments.”

Source: S Kumar et al. Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. BMJ 15 February 2018; doi: 10.1136/bmj.k342

Link: http://www.bmj.com/content/360/bmj.k342



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