title: Relation of Stroke and Major Bleeding to Creatinine Clearance in Patients With Atrial Fibrillation (from the Fushimi AF Registry).
abstract: Creatinine clearance (CrCl) has been widely used to adjust the dosage of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation (AF) and exclude contraindicated patients. However, there are few available real-world data on the relation between CrCl and adverse clinical outcomes in patients with AF. Therefore, we evaluated the clinical characteristics and adverse events in Japanese patients with AF stratified by CrCl. We categorized patients in the Fushimi AF Registry, a large prospective community-based Japanese cohort of patients with AF, into 3 groups as follows: (1) CrCl <30 ml/min, (2) CrCl 30 to 49 ml/min, and (3) CrCl ≥50 ml/min. We evaluated 3,080 patients after a median follow-up of 1,076 days. Comparing with patients with CrCl ≥50 ml/min, patients with AF with CrCl <30 ml/min showed increased risks of stroke/systemic embolism (SE) (hazard ratio [HR] 1.68; 95% confidence interval [CI] 1.04 to 2.65; p = 0.04) and major bleeding (HR, 2.08; 95% CI 1.23 to 3.39; p = 0.008) after adjustment for prespecified factors. Patients with AF with CrCl <30 ml/min were also associated with higher risks of all-cause death, hospitalization for heart failure, myocardial infarction, or the composite of all-cause death and stroke/SE. However, no excess risk of stroke/SE (HR 1.10; 95% CI 0.76 to 1.58; p = 0.6) or major bleeding (HR 0.98; 95% CI 0.63 to 1.48; p = 0.9) was noted for patients with CrCl 30 to 49 ml/min. In conclusion, Japanese patients with AF with CrCl <30 ml/min were closely associated with adverse clinical events including stroke/SE and major bleeding.
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Nobutoyo
authors.initials: N
authors.lastname: Masunaga
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
authors.forename: Yeong-Hwa
authors.initials: YH
authors.lastname: Chun
authors.affiliation: Tsuji Clinic, Kyoto, Japan.
authors.forename: Hikari
authors.initials: H
authors.lastname: Tsuji
authors.affiliation: Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. Electronic address: akao@kuhp.kyoto-u.ac.jp.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015331:Cohort Studies; D003404:Creatinine / Q000032:analysis*; D004617:Embolism / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D012042:Registries; D012306:Risk; D020521:Stroke / Q000453:epidemiology*
chemical_list: D003404:Creatinine