Meta-analysis of safety and efficacy for direct oral anticoagulation treatment of non-valvular atrial fibrillation in relation to renal function

Zou, Rongjun; Tao, Jun; Shi, Wu; Yang, Minglei; Li, Hongmu; Lin, Xuemei; Yang, Shiming; Hua, Peng

doi:10.1016/j.thromres.2017.10.013

Cited by 33 publications

(26 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The decline in renal function over time in our cohort was greater than previously observed in landmark randomised controlled trials comparing NOACs and warfarin in patients with non-valvular AF 4 8 11 12. In our analysis, the mean decline in CrCl during 24-month follow-up was −7.33 mL/min for NOACs and −6.36 mL/min for warfarin.…”

Section: Discussioncontrasting

confidence: 54%

“…Decline in renal function is common in patients with AF. A meta-analysis of four trials comparing the efficacy and safety of NOACs relative to warfarin showed that estimated glomerular filtration rate (eGFR) declined in patients treated with either warfarin or NOACs (−3.66 mL/min/1.73 m² for warfarin; −2.54 mL/min/1.73 m² for NOACs at 30 months after randomisation) 4. Such declines are expected to be greater in routine practice as patients in clinical trials tend to be younger and healthier.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation

Inohara

Holmes

Pieper

et al. 2020

Heart

View full text Add to dashboard Cite

ObjectiveNon-vitamin K oral anticoagulants (NOACs) require dose adjustment for renal function. We sought to investigate change in renal function over time in patients with atrial fibrillation (AF) and whether those on NOACs have appropriate dose adjustments according to its decline.MethodsWe included patients with AF enrolled in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry treated with oral anticoagulation. Worsening renal function (WRF) was defined as a decrease of >20% in creatinine clearance (CrCl) from baseline. The US Food and Drug Administration (FDA)-approved package inserts were used to define the reduction criteria of NOACs dosing.ResultsAmong 6682 patients with AF from 220 sites (median age (25th, 75th): 72.0 years (65.0, 79.0); 57.1% male; median CrCl at baseline: 80.1 mL/min (57.4, 108.5)), 1543 patients (23.1%) experienced WRF with mean decline in CrCl during 2 year follow-up of −6.63 mL/min for NOACs and −6.16 mL/min for warfarin. Among 4120 patients on NOACs, 154 (3.7%) patients had a CrCl decline sufficient to warrant FDA-recommended dose reductions. Of these, NOACs dosing was appropriately reduced in only 31 (20.1%) patients. Compared with patients with appropriately reduced NOACs, those without were more likely to experience bleeding complications (major bleeding: 1.7% vs 0%; bleeding hospitalisation: 2.6% vs 0%) at 1 year.ConclusionsIn the US practice, about one-fourth of patients with AF had >20% decline in CrCl over time during 2 year follow-up. As a result, about 3.7% of those treated with NOACs met guideline criteria for dose reduction, but of these, only 20.1% actually had a reduction.

show abstract

Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation

Inohara

Holmes

Pieper

et al. 2020

Heart

View full text Add to dashboard Cite

show abstract

“…However, these studies reported on renal function at the initiation of oral anticoagulants (OACs), and changes in renal function over time were not taken into account. 18 Previous studies showed that a significant proportion of AF patients, ranging from 21%…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Changes in renal function in patients with atrial fibrillation: Efficacy and safety of the non–vitamin K antagonist oral anticoagulants

Miyazawa

Pastori

Lip³

2018

American Heart Journal

View full text Add to dashboard Cite

Link to publication on Research at Birmingham portal General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. • Users may freely distribute the URL that is used to identify this publication. • Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research. • User may use extracts from the document in line with the concept of 'fair dealing' under the Copyright, Designs and Patents Act 1988 (?) • Users may not further distribute the material nor use it for the purposes of commercial gain. Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

show abstract

“…В мета-анализе 5 РКИ R. Zou и соавт. более детально дана оценка влияния НПОАК по сравнению с варфарином на эффективность и безопасность у больных неклапанной ФП в зависимости от тяжести почечной дисфункции, но также не включались пациенты с клиренсом креатинина менее 30 мл / мин [88]. При использовании НПОАК по сравнению с варфарином риск развития инсульта был достоверно ниже (ОР 0,79 при 95 % ДИ от 0,68 до 0,91) как у больных с мягкой (клиренс креатинина 45-59 мл / мин), так и у больных с умеренной (клиренс креатинина 30-44 мл / мин) дисфункцией почек (ОР 0,80 при 95 % ДИ от 0,69 до 0,92).…”

Section: выбор антикоагулянтов у больных C неклапанной фп и хбпunclassified

Nonvalvular Atrial Fibrillation and Diabetic Nephropathy: Epidemiology, Prognosis, and Choice of Anticoagulant Therapy

Козиолова¹,

Polyanskaya²,

Суровцева³

et al. 2018

CARDIO

View full text Add to dashboard Cite

Эпидемиология фибрилляции предсердий (ФП) и сахарного диабета (СД) 2-го типа Согласно эпидемиологическим исследованиям, СД 2-го типа в структуре коморбидной патологии является одним из наиболее частых сопутствующих заболеваний у больных неклапанной ФП [1]. Так, по данным регистра PREFER in AF, в Европе частота развития СД 2-го типа у пациентов с ФП дости-гает 23 % [2]. Результаты европейского пилотного регистра EORP-AF показали, что у больных с ФП распространенность СД 2-го типа составила 20,6 % [3]. При этом постоянная форма ФП встречалась достоверно чаще, чем пароксизмальная (21,5 % против 16 %; p=0,0022). Наибольшая распространенность СД 2-го типа среди больных с ФП представлена в регистре ORBIT AF, которая составила 29,5 % [4]. Согласно одной из европейских

show abstract

Meta-analysis of safety and efficacy for direct oral anticoagulation treatment of non-valvular atrial fibrillation in relation to renal function

Cited by 33 publications

References 29 publications

Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation

Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation

Changes in renal function in patients with atrial fibrillation: Efficacy and safety of the non–vitamin K antagonist oral anticoagulants

Nonvalvular Atrial Fibrillation and Diabetic Nephropathy: Epidemiology, Prognosis, and Choice of Anticoagulant Therapy

Contact Info

Product

Resources

About