The impact of renal function on efficacy and safety of new oral anticoagulant in atrial fibrillation patients

Abstract

Background and objectives This meta-analysis was to investigate the efficacy and safety of new oral anticoagulant (NOAC) in atrial fibrillation (AF) patients with renal function insufficiency, and to explore whether renal decline occurs in AF patients with NOAC and its impact on outcomes. Methods and results In AF patients with mild renal insufficiency, the NOAC was associated with significantly lower rates of stroke (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67–0.91; P < .05). Lower rates of bleeding were significantly observed in NOAC group (OR, 0.85; 95% CI, 0.75–0.97; P < .05). In AF patients with moderate renal impairment, similar results were revealed (OR for stroke or systemic embolism, 0.80; 95% CI, 0.67–0.95, P < .05; OR for major bleeding, 0.78; 95% CI, 0.59–1.03; P = .07). During the follow-up, pooled data revealed that NOAC showed a less renal toxicity, but the difference did not reach statistical significance (creatinine clearance decline: −0.12 mL/min [−0.84, 0.61 mL/min]). We have revealed that the NOACs were associated with significantly lower rates of stroke or systemic embolism (hazard ratio [HR], 0.66; 95% CI, 0.42–0.89; P < .05) and lower rates of bleeding (HR, 0.93; 95% CI, 0.70–1.16; P = .153) in AF patients with worsening renal function. Conclusions NOAC may have the potentiality to be at least as effective as warfarin and may equal safety outcomes in AF patients with renal impairment. Renal decline during therapeutics may be less likely happened in NOAC than warfarin dose. NOAC may reveal good efficacy and safety outcomes in these scenarios. Further detailed research is needed to gain more clear profile on this new anticoagulant.

Relationship between serum lipid levels and ischemic stroke in patients with atrial fibrillation: a nested case–control study based on the China Atrial Fibrillation Registry

“…Since the different distribution of NOAC users could introduce bias, NOAC was included as a covariate in the conditional logistic regression models. Still, regarding NOAC therapy, our findings are in line with previous study, reporting decreased ischemic stroke, remarkably low rate of systemic embolism and bleeding in AF patients [30], which suggests that patients receiving NOAC might have lower rate of ischemic stroke. The results of this study did suggest that TG levels were an important factor in ischemic stroke in patients with AF.…”

Comparing the Efficacy and Safety of Apixaban Versus Warfarin in Morbidly Obese Patients

“…Renal functions were proven to significantly modulate the efficacy and safety of oral anticoagulants [ 24 ]. DOACs were reported to have altered pharmacokinetic properties in patients with renal dysfunction, but limited data are available regarding their use in these patients [ 25 ].…”

Kidney Function and the Use of Vitamin K Antagonists or Direct Oral Anticoagulants in Atrial Fibrillation

“…Comparisons between the effects of DOACs and of vitamin K antagonists in different stages of kidney failure have been done. In a recent meta-analysis by Gui, 32 encompassing the five randomized phase III clinical trials of the four currently available NOACs versus warfarin trials [11][12][13][14]33 with pooled data of close to 73,000 participants with nonvalvular AF, the efficacy (defined as stroke or systemic embolism) and safety (major bleeding) of the aforementioned drugs in patients with renal failure were investigated. Due to the exclusion of patients with severe renal dysfunction (eGFR 15-29 mL/min/1.73 m 2 ) and patients on kidney replacement therapy from those trials, the analyzed population consisted of patients with mild renal failure (eGFR 50-79 mL/min/1.73 m 2 ) and moderate renal failure (eGFR 30-49 mL/min/1.73 m 2 ).…”