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A real-world exploration into clinical outcomes of direct oral anticoagulant therapy in people with chronic kidney disease: a large hospital-based study.
Nwanosike, Ezekwesiri Michael; Merchant, Hamid A; Sunter, Wendy; Ansari, Muhammad Ayub; Conway, Barbara R; Hasan, Syed Shahzad.
Afiliación
  • Nwanosike EM; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, HD1 3DH, UK.
  • Merchant HA; Calderdale and Huddersfield Pharmacy Services, Anticoagulation Services, Calderdale and Huddersfield NHS Foundation Trust Hospitals, Lindley, Huddersfield, HD3 3EA, UK.
  • Sunter W; Department for Bioscience, School of Health, Sport and Bioscience, The University of East London, London, E16 2RD, UK.
  • Ansari MA; Calderdale and Huddersfield Pharmacy Services, Anticoagulation Services, Calderdale and Huddersfield NHS Foundation Trust Hospitals, Lindley, Huddersfield, HD3 3EA, UK.
  • Conway BR; Calderdale and Huddersfield Pharmacy Services, Anticoagulation Services, Calderdale and Huddersfield NHS Foundation Trust Hospitals, Lindley, Huddersfield, HD3 3EA, UK.
  • Hasan SS; School of Computing and Engineering, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
J Nephrol ; 37(5): 1227-1240, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38564072
ABSTRACT

BACKGROUND:

There is limited evidence to support definite clinical outcomes of direct oral anticoagulant (DOAC) therapy in chronic kidney disease (CKD). By identifying the important variables associated with clinical outcomes following DOAC administration in patients in different stages of CKD, this study aims to assess this evidence gap.

METHODS:

An anonymised dataset comprising 97,413 patients receiving DOAC therapy in a tertiary health setting was systematically extracted from the multidimensional electronic health records and prepared for analysis. Machine learning classifiers were applied to the prepared dataset to select the important features which informed covariate selection in multivariate logistic regression analysis.

RESULTS:

For both CKD and non-CKD DOAC users, features such as length of stay, treatment days, and age were ranked highest for relevance to adverse outcomes like death and stroke. Patients with Stage 3a CKD had significantly higher odds of ischaemic stroke (OR 2.45, 95% Cl 2.10-2.86; p = 0.001) and lower odds of all-cause mortality (OR 0.87, 95% Cl 0.79-0.95; p = 0.001) on apixaban therapy. In patients with CKD (Stage 5) receiving apixaban, the odds of death were significantly lowered (OR 0.28, 95% Cl 0.14-0.58; p = 0.001), while the effect on ischaemic stroke was insignificant.

CONCLUSIONS:

A positive effect of DOAC therapy was observed in advanced CKD. Key factors influencing clinical outcomes following DOAC administration in patients in different stages of CKD were identified. These are crucial for designing more advanced studies to explore safer and more effective DOAC therapy for the population.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Nephrol Asunto de la revista: NEFROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Italia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Nephrol Asunto de la revista: NEFROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Italia