Association of different oral anticoagulants use with renal function worsening in patients with atrial fibrillation: A multicentre cohort study

Pastori, Daniele; Ettorre, Evaristo; Lip, Gregory Y.H.; Sciacqua, Angela; Perticone, Francesco; Melillo, Francesco; Godino, Cosmo; Marcucci, Rossella; Berteotti, Martina; Violi, Francesco; Pignatelli, Pasquale; Saliola, Mirella; Menichelli, Danilo; Casciaro, Marco; Menafra, Vito

doi:10.1111/bcp.14350

Cited by 27 publications

(16 citation statements)

References 23 publications

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“…There was a small, statistically significant decline in renal function among patients receiving rivaroxaban compared with patients receiving warfarin in the subgroup analysis of ROCKET-AF trial [6,7]. In a recent multicenter prospective cohort study, Pastori et al reported that DOACs provided a slower decline in renal function compared to those using warfarin [9]. Therefore, the results about the decline in renal function after long-term anticoagulants use is still controversial and the underlying mechanism is not clear.…”

Section: Anticoagulants Use and The Decline In Renal Functionmentioning

confidence: 99%

“…On the contrary, in the US medical care database, rivaroxaban was associated with a 19% reduction in the hazard of acute kidney injury (AKI) and an 18% reduction in progression to stage 5 CKD or hemodialysis compared with warfarin in patients with AF [ 8 ]. Moreover, in a recent multicenter prospective cohort study, patients taking direct oral anticoagulants (DOACs) showed a slower decline in renal function compared with those taking warfarin, but the favorable association between DOAC use and decline of renal function was partially lost in patients with diabetes [ 9 ]. Thus, there are different impacts of DOACs and warfarin on renal decline in different population with AF.…”

Section: Introductionmentioning

confidence: 99%

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The impact on renal function after long-term use of anticoagulants in atrial fibrillation patients

Lee

et al. 2021

Thrombosis J

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Objective Long-term oral anticoagulant should be considered or recommended in patients with atrial fibrillation (AF) and CHA2DS2VASc score ≥ 1 for stroke prevention. Warfarin and different direct oral anticoagulants (DOACs) are metabolized differently by the kidney. The impact on renal function after long-term use of anticoagulants in the patients with AF remains unclear. This study aimed to compare DOACs and warfarin’s impact on the decline in renal function from a large cohort with AF. Methods This study included patients with nonvalvular AF from 2000 to 2018, mainly through the medical history (ICD code) of the Chang Gung Research Database. Baseline estimated glomerular filtration rate (eGFR), follow-up eGFR and the change in eGFR between 2-year eGFR and baseline eGFR were compared between different DOACs and warfarin after propensity score matching. The primary study endpoint was acute kidney injury (AKI). Results 3657 patients were enrolled in this study and the mean observation time was 3.3 ± 0.9 years. During the observation period, there was a significantly higher incidence of AKI during follow-up in the warfarin group than in the different DOAC groups before and after propensity score matching (before: warfarin vs. DOAC: 9.2% vs. 5.2%, p < 0.001; after: warfarin vs. DOAC: 8.9% vs. 4.4%, p < 0.001). There was no difference in the incidence of AKI between dabigatran group and anti-factor Xa inhibitor group after propensity score matching. The incidence of AKI was similar among rivaroxaban, apixaban and edoxaban groups after propensity score matching. The change in eGFR between 2-year eGFR and baseline eGFR did not differ between the warfarin and DOAC groups after propensity score matching (warfarin vs. DOAC: − 1.27 ± 20.32 vs. -1.94 ± 17.24 mL/min/1.73 m2, p = 0.461). Conclusions During the mean observation time of 3.3 ± 0.9 years, warfarin was associated with a higher incidence of AKI compared with DOACs. The decline in renal function did not differ among warfarin and different DOAC groups.

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Section: Anticoagulants Use and The Decline In Renal Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact on renal function after long-term use of anticoagulants in atrial fibrillation patients

Lee

et al. 2021

Thrombosis J

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“…Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended in preference to vitamin K antagonists for stroke prevention in high risk AF patients without EHRA type I VHDs [1]. And taking NOACs was conducive to postponing the deterioration of renal function compared to use of warfarin [21]. However, NOACs were not always available due to their high costs and unsupported by local health insurance in China, thus warfarin was still the only recorded oral anticoagulant in our study population.…”

Section: Table 4 Multivariable Cox Regression Analysis Of All-cause Dmentioning

confidence: 98%

Impact of estimated glomerular filtration rate on long-term clinical outcomes among Chinese patients with atrial fibrillation

Wan

Wang

Yang

et al. 2020

BMC Cardiovasc Disord

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Background Estimated glomerular filtration rate (eGFR) is a widely accepted indicator of renal function. The aim of this study was to evaluate the relationship between eGFR and 3-year clinical outcomes among Chinese patients with atrial fibrillation (AF). Methods We retrospectively studied 433 consecutive Chinese patients with AF (51.0% males, mean age 65.6 ± 13.2 years) between February 2013 and December 2017. Baseline clinical data were collected according to medical records. eGFR was calculated by MDRD equation for Chinese patients according to baseline age, sex and serum creatinine. The primary clinical outcome of interest was all-cause mortality. Results During a median follow-up period of 3.1 (0.5–4.5) years, 73 deaths (16.9%) were recorded. Multivariate Cox regression analyses indicated that eGFR was independently associated with all-cause death in total population [hazard ratio (HR) 0.984; 95% confidence interval (CI) 0.972–0.995, P = 0.006] and patients free of valvular heart diseases (VHDs) (HR 0.975; 95% CI 0.959–0.992, P = 0.003), but not with VHDs. A receiver operating characteristic (ROC) analysis revealed that reduced eGFR predicted all-cause mortality with areas under the ROC curve of 0.637 (95% CI 0.539–0.735, P = 0.004) in AF patients free of VHDs. Conclusions eGFR is an independent predictor of 3-year all-cause mortality among Chinese patients with AF, especially among those patients free of VHDs.

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“…In contrast, DOACs have consistently demonstrated more preservation, or slower decline in renal function, compared with warfarin. [59][60][61] Dabigatran 75 mg twice daily is recommended for patients with a CrCl 15 to less than 30 mL/min. 14 Although this dose provides similar PK/PD compared with those receiving 150 mg twice daily with normal renal function, data are otherwise limited, and sometimes still suggest worse outcomes compared with warfarin.…”

Section: Advanced Renal Impairment Summarymentioning

confidence: 99%

Direct Oral Anticoagulants in the Treatment of Venous Thromboembolism: Use in Patients with Advanced Renal Impairment, Obesity, or Other Weight-Related Special Populations

Dobesh

Kernan

Lueshen

2021

Semin Respir Crit Care Med

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There are currently more than 7 million patients taking a direct oral anticoagulant (DOAC), with more new prescriptions per year than warfarin. Despite impressive efficacy and safety data for the treatment of venous thromboembolism, patients with obesity or advanced renal impairment represented a small portion of the patients enrolled in the phase 3 clinical trials. Therefore, to evaluate the potential use of DOACs in these special populations, clinicians need to have an understanding of the pharmacokinetics and pharmacodynamics of these agents in these settings. Since data from randomized controlled trials are limited, data from observational trials are helpful in gaining comfort with the use of DOACs in these special populations. Selecting the appropriate dose for each agent is imperative in achieving optimal patient outcomes. We provide an extensive review of the pharmacokinetics, pharmacodynamics, phase 3 clinical trials, and observational studies on the use of DOACs in patients with advanced renal impairment, obesity, or other weight-related special populations to provide clinicians with a comprehensive understanding of the data for optimal drug and dose selection.

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Association of different oral anticoagulants use with renal function worsening in patients with atrial fibrillation: A multicentre cohort study

Cited by 27 publications

References 23 publications

The impact on renal function after long-term use of anticoagulants in atrial fibrillation patients

The impact on renal function after long-term use of anticoagulants in atrial fibrillation patients

Impact of estimated glomerular filtration rate on long-term clinical outcomes among Chinese patients with atrial fibrillation

Direct Oral Anticoagulants in the Treatment of Venous Thromboembolism: Use in Patients with Advanced Renal Impairment, Obesity, or Other Weight-Related Special Populations

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