Do direct oral anticoagulants prevent stroke and systemic embolic events as effectively as warfarin without increasing major bleeding in atrial fibrillation patients with chronic kidney disease?
DOACs are as effective as warfarin for stroke prevention without increasing major bleeding risk in atrial fibrillation patients with chronic kidney disease, particularly stage G3.
Our findings indicate that DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding. The major limitation is that the results of this study chiefly reflect CKD stage G3. Application of the results to CKD stage G4 patients requires additional investigation. Furthermore, we could not assess CKD stage G5 patients. Future reviews should assess participants at more advanced CKD stages. Additionally, we could not conduct detailed analyses of subgroups and sensitivity analyses due to lack of data.
Kimachi et al. (Mon,) studied this question.