Why the study?
Advanced CKD, including ESRD on dialysis, increases thromboembolic risk in AF patients, but the comparative safety and efficacy of DOAC versus warfarin or no OAC required evaluation.
Does direct-acting oral anticoagulant (DOAC) improve clinical outcomes and reduce bleeding in non-valvular AF patients with advanced CKD or ESRD on dialysis compared to warfarin or no OAC?
Does direct-acting oral anticoagulant (DOAC) improve clinical outcomes and reduce bleeding in non-valvular AF patients with advanced CKD or ESRD on dialysis compared to warfarin or no OAC?
In patients with non-valvular AF and advanced CKD or ESRD on dialysis, DOACs are associated with lower bleeding risk compared to warfarin and lower composite adverse outcomes compared to no OAC.
PURPOSE: Advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD) on dialysis, increases thromboembolic risk among patients with atrial fibrillation (AF). This study examined the comparative safety and efficacy of direct-acting oral anticoagulant (DOAC) compared to warfarin or no oral anticoagulant (OAC) in AF patients with advanced CKD or ESRD on dialysis. MATERIALS AND METHODS: Using data from the COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry, 260 non-valvular AF patients with advanced CKD (defined as estimated glomerular filtration rate <30 mL/min per 1.73/m²) or ESRD on dialysis were enrolled from June 2016 to July 2020. The study population was categorized into DOAC, warfarin, and no OAC groups; and differences in major or clinically relevant non-major (CRNM) bleeding, stroke/systemic embolism (SE), myocardial infarction/critical limb ischemia (CLI), and death were assessed. CONCLUSION: Among AF patients with advanced CKD or ESRD on dialysis, DOAC was associated with a lower risk of major or CRNM bleeding compared to warfarin and a lower risk of composite adverse clinical outcomes compared to no OAC. ClinicalTrials.gov (NCT02786095).
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Park et al. (2022) studied this question.
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