This comprehensive review examined the cardiovascular-kidney-metabolic interplay in AF patients on DOACs, exploring how CKM syndrome affects anticoagulation efficacy, safety, and dosing decisions.
We included 17,378 AF patients (mean age 76.1±10.7 years; 40.9% women) on DOACs from a multicenter Taiwanese database (2012-2021). Patients were followed until outcomes, death, or study end.
Overall, 18.2%, 35.0%, 32.2%, and 14.6% of patients had 0, 1, 2, and 3 CKM domains. Women more often exhibited kidney, metabolic, or combined domains. Clinical risks rose stepwise with domain number; patients with 3 domains had the highest risks of ischemic stroke/systemic embolic event/acute coronary syndrome (adjusted hazard ratio (aHR) 1.60, 95% confidence interval (CI) 1.25-2.05), major bleeding (aHR 2.60, 95%CI 2.00-3.38), heart failure hospitalization (aHR 2.83, 95%CI 2.38-3.37), all-cause mortality (aHR 1.80, 95%CI 1.58-2.06), acute kidney injury (aHR 3.42, 95%CI 2.76-4.25), and major adverse renal events (aHR 20.84, 95%CI 14.14-30.71; all p<0.001). Domain-specific analysis showed kidney involvement conferred the strongest risks (except IS/SEE/ACS), while cardiovascular and metabolic domains were more associated with IS/SEE/ACS. YLL rose with more CKM domains, with females associated with greater reductions, especially in cardiovascular (-10.29 vs. -4.67) and metabolic (-4.98 vs. -0.80) domains (p<0.001).
Increasing CKM burden was associated with progressively worse prognosis and shorter life expectancy in AF patients on DOACs, with more pronounced impacts in women.
