STROKE RISK IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERITONEAL DIALYSIS ON ORAL ANTICOAGULANTS - A COHORT STUDY WITH SEQUENTIAL TRIAL APPROACH

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Abstract Title *

STROKE RISK IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERITONEAL DIALYSIS ON ORAL ANTICOAGULANTS - A COHORT STUDY WITH SEQUENTIAL TRIAL APPROACH

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Co-author 1

Min Fan minfan@connect.hku.hk The University of Hong Kong Department of Pharmacology and Pharmacy Hong Kong Hong Kong, China -

Co-author 2

Crystal Lam lty1020@connect.hku.hk The University of Hong Kong Department of Pharmacology and Pharmacy Hong Kong Hong Kong, China -

Co-author 3

Karin Poon ka.poon.21@ucl.ac.uk UCL School of Pharmacy London United Kingdom -

Co-author 4

Sydney Tang scwtang@hku.hk The University of Hong Kong School of Clinical Medicine Hong Kong Hong Kong, China -

Co-author 5

Franco Cheng francowt@hku.hk The University of Hong Kong Department of Pharmacology and Pharmacy Hong Kong Hong Kong, China *

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Introduction

The use of oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who are undergoing peritoneal dialysis (PD) is controversial. This study aimed to evaluate the effectiveness and safety of OAC initiation in this specific patient population within Hong Kong.

Methods

A sequential target trial emulation was conducted using a retrospective cohort from the Hong Kong Hospital Authority's electronic database (2007-2022). The study included PD patients with incident AF/AFL and no prior stroke. In a series of 191 monthly sequential trials, OAC initiators were matched 1:10 to non-initiators using propensity scores. The primary outcome was a composite of ischemic stroke, haemorrhagic stroke, and all-cause mortality over three years. The primary safety outcome was a composite of major bleeding events.

Results

Of 8,230 eligible patients, only 81 (0.98%) were OAC initiators. After matching, the cohort consisted of 81 OAC initiators and 806 non-initiators. Over a median follow-up of 357 days, the 3-year cumulative incidence of the composite stroke and mortality outcome was similar between groups (risk difference [RD]: -0.03%, 95% CI: -0.18% to 0.11%). Likewise, no significant difference was observed for the composite bleeding outcome (RD: -0.01%, 95% CI: -0.15% to 0.12%). Subgroup analyses by age and sex, as well as sensitivity analyses, yielded consistent results.

Conclusion

The initiation of oral anticoagulants was not associated with a significant reduction in the risk of stroke, mortality, or major bleeding. These findings suggest that the benefits of OACs in this high-risk population remain uncertain.

Kewords