Abstract WP171: Antithrombotic Therapy for Secondary Stroke Prevention in Patients with Severe Chronic Kidney Disease and Atrial Fibrillation

• DOI: 10.1161/str.56.suppl_1.wp171
• Publication Date: 2025-01-30T10:33:28Z
• Authors: Erica Jones; Iyanuoluwa Ayodele; Emily Obrien; Daniel Laskowitz; Gregg Fonarow; Roland Matsouaka; Lee Schwamm; Eric Smith; Deepak Bhatt; Eric Peterson; Ying Xian
• Keywords: Stroke; Secondary Prevention; Fibrinolytic agent

Background: The prevalence of renal disease is increasing in the U.S. Renal dysfunction increases risk atrial fibrillation, ischemic stroke and systemic bleeding. Lack randomized trial data this population has led to conflicting recommendations on management. Our objective was review a decade practice utilization antithrombotics including oral anticoagulants (OACs) for secondary prevention patients with severe dysfunction. Methods: We analyzed all fibrillation impaired function (creatinine clearance < 30) who were discharged Get Guidelines- Stroke registry from Jan 2013 – Dec 2023. Subjects other indication anticoagulation such as venous thromboembolism, pulmonary embolism, prosthetic valve excluded. For analysis, subjects categorized advanced chronic kidney (CKD, CrCl 15-30) end stage (ESRD, CrCl<15). Results: Of 67,209 meeting inclusion criteria, 55,501 (82.6%) classified CKD 11,708 (17.4%) ESRD. Apixaban most utilized antithrombotic both groups (41% 40% ESRD) followed by warfarin ESRD group (24%) aspirin monotherapy (20%) group. Among those apixaban 5mg dose, 24.5% met criteria lower 2.5mg yet treated standard dose. Many same anticoagulant they taking at admission: 26%, 85%, rivaroxaban 33%, dabigatran 58%. From 2023, increased 1.1% 63.5% 0.6% 66.9% Aspirin decreased 27% 14% 25% Conclusions: Trends OAC show uptake use OACs, particularly apixaban, over antiplatelets population. More needed determine risk/benefit DOAC vs Vitamin K antagonists, role antiplatelets, inappropriate dosing DOACs management “failure” patients.