Background and Objectives: Recent randomized trials of oral antithrombotic drugs with
atrial flutter (AFL) excluded patients with renal impairment because of their increased risk of
bleeding. To date, no relevant studies have assessed the effectiveness and safety of different antithrombotic drugs in
chronic kidney disease (CKD) patients with AFL. This cohort study evaluated the effectiveness and safety of different antithrombotic drugs in CKD patients with AFL. This study also investigated the risk of cardiovascular events from antithrombotic drugs through different risk profiles of
stroke stratified by the CHA2DS2-VASc score. Materials and Methods: This cohort study was performed in patients with AFL and CKD who were extracted from the National Health Insurance (NHI) Database in Taiwan. Oral antithrombotic
therapy (oral
anticoagulants (OAC) or antiplatelets (
APT)) was administered to patients who had been diagnosed with AFL after being diagnosed with CKD between 2011 and 2015. Primary outcomes, including
ischemic stroke, systemic
embolism, and composite of
stroke, and secondary outcomes, including
major adverse cardiac events (MACEs), major
bleeding, all-cause mortality, and cardiovascular-related death, were examined. Results: A total of 2468 patients were included in this study. The results showed no statistically significant differences in the risk of primary outcomes. For the secondary outcomes, there were also no statistically significant differences in the risk of MACEs and major
bleeding. However, the pooled results indicated that the hazard ratio (HR) for all-cause mortality with OAC was 0.24 (95% confidence interval (CI) = 0.10-0.55) compared with combination
therapy, and the HR for
APT compared with OAC was 2.86 (95% CI = 1.48-5.53). Conclusions: In the studied population, OAC or
APT alone were proved equally effective for
stroke prophylaxis. Furthermore, OAC might reduce the all-cause mortality rate compared with
APT and should be considered as the first choice of oral antithrombotic drugs in patients with AFL and CKD.