Real‐world stroke prevention strategies in nonvalvular atrial fibrillation in patients with renal impairment. (16th May 2017)

• Record Type: Journal Article
• Authors: Mert, Kadir U.; Mert, Gurbet Ö.; Başaran, Özcan; Beton, Osman; Dogan, Volkan; Tekinalp, Mehmet; Aykan, Ahmet Ç.; Kalaycıoğlu, Ezgi; Bolat, Ismail; Taşar, Onur; Şafak, Özgen; Kalçık, Macit; Yaman, Mehmet; Kırma, Cevat; Biteker, Murat
• Other Names: İnci Sinan investigator.; Altıntaş Bernas investigator.; Kalkan Sedat investigator.; Karadeniz Özpamuk investigator.; Tekkesin İlker investigator.; Çakıllı Yasin investigator.; Türkkan Ceyhan investigator.; Hamidi Mehmet investigator.; Demir Vahit investigator.; Gürsoy Ozan investigator.; Öztürk Tek investigator.; Aksan Gökhan investigator.; Seyis Sabri investigator.; Ballı Mehmet investigator.; Alici Hayri investigator.; Bozyel Serdar investigator.; Çalık Feyza investigator.; Karaca Oğuz investigator.; Helvacı Füsun investigator.; Akay Kadriye investigator.; Çanga Yiğit investigator.; Çelebi Savaş investigator.; Altuntas Emine investigator.; Aytürk Mehmet investigator.; Güneş Murat investigator.; Bezgin Tahir investigator.; Aksakal Aytekin investigator.; Çakal Beytullah investigator.; Çolak Ayşe investigator.; Kaplan Özgür investigator.; Tatlısu Adem investigator.; Gözübüyük Gökhan investigator.; Demirelli Selami investigator.; Kaya Adnan investigator.; Rencüzoğulları İbrahim investigator.; Bayram Zübeyde investigator.; Şimşek Zeki investigator.; Civan Murat investigator.; Batgharel Ulaankhu investigator.; Ata Ekber investigator.; Göl Gökhan investigator.; Değirmencioğlu Aleks investigator.; Candan Özkan investigator.; Çelebi Özcan investigator.; Doğan Cem investigator.; Yavuz Fethi investigator.; Ulucan Şeref investigator.; Arısoy Arif investigator.; Şahin Dilekçi investigator.; Ermiş Emrah investigator.; Gökaslan Serkan investigator.; Pektaş İdris investigator.; Tanındı Aslı investigator.; Tekin Kamuran investigator.; Sancar Memic investigator.; Çekiç Güvenç investigator.; Başaran Filiz investigator.; Altun Ibrahim investigator.; Soylu Özcan investigator.;
• Is Part Of: European journal of clinical investigation. Volume 47:Number 6(2017)
• Page Start: 428
• Page End: 438
• Publication Date: 2017-05-16
• Subjects: Atrium fibrillation -- glomerular filtration rate -- prevention -- renal impairment -- stroke; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.12758
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Background: The data regarding stroke prevention strategies in nonvalvular atrial fibrillation (NVAF) are limited especially in patients with renal impairment (RI). We sought to evaluate management dilemmas in patients with concurrent NVAF and RI in RAMSES (ReAl‐life Multicenter Survey Evaluating Stroke Prevention Strategies inTurkey) study. Methods: We conducted a prospective, multicenter, nation‐wide registry in NVAF patients in outpatient cardiology clinics. All consecutive patients with NVAF were enrolled in RAMSES study (ClinicalTrials.gov identifier NCT02344901). The baseline data were collected. Glomerular filtration rate (GFR) was estimated by Cockcroft–Gault equation. Results: A total number of 6273 patients from 29 provinces of Turkey with the contribution of 83 investigators were enrolled to the study. Of the study population, 1964(33%) patients had RI which was defined as GFR < 60 mL/min. Patients with RI had significantly higher CHA2 DS2 VASc and HAS‐BLED scores compared to those without RI (3·9 ± 1·5 vs. 2·9 ± 1·5, and 2·0 ± 1 vs. 1·4 ± 1; P < 0·001). Prior history of major bleeding (6·9% vs. 4·1%, P < 0·001) and stroke (16·2% vs. 11·8%, P < 0·001) was significantly higher among individuals with concomitant RI and NVAF. Although RI patients had a higher risk for thromboembolism, number of the patients who did not receive any anticoagulant therapy was higher in patients with RI than without RI (30·1 vs. 26·4%, P = 0·003). Conclusion: RAMSES study showed that one‐third of the patients with NVAF had RI in the real‐world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one‐third of these patients did not receive any anticoagulant therapy.