Key result
DOACs linked to ~71% lower stroke or systemic embolism risk versus warfarin in advanced kidney disease.
Why the study?
The effectiveness and safety of direct oral anticoagulants in patients with atrial fibrillation and advanced kidney disease had not been fully established.
Do direct oral anticoagulants reduce stroke/systemic embolism and major bleeding compared to warfarin in patients with atrial fibrillation and advanced kidney disease?
Cohort (n=1,011)
No
Do direct oral anticoagulants reduce stroke/systemic embolism and major bleeding compared to warfarin in patients with atrial fibrillation and advanced kidney disease?
In patients with atrial fibrillation and advanced kidney disease, DOACs (particularly apixaban) are associated with a lower risk of ischemic events and comparable or lower bleeding risks compared to warfarin.
Answers are grounded in this paper and cite their sources.
DOACs were associated with lower stroke risk in AF with advanced CKD; extends observational data but leaves open need for randomized confirmation.
BACKGROUND: The effectiveness and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and advanced kidney disease (AKD) has not been fully established. OBJECTIVES: To determine the effectiveness and safety related to pooled or specific DOACs to that with warfarin in patients with AF and AKD. METHODS: Patients with AF and AKD (estimated glomerular filtration rate < 30 mL/min) who received DOAC or warfarin from July 2011 to December 2020 were retrospectively identified in a medical center in Taiwan. Primary outcomes were hospitalized for stroke/systemic embolism and major bleeding. Secondary outcomes included any ischemia and any bleeding. RESULTS: A total of 1,011 patients were recruited, of whom 809 (80.0%) were in the DOACs group (15.3% dabigatran, 25.4% rivaroxaban, 25.2% apixaban, and 14.1% edoxaban), and 202 (20.0%) in the warfarin group. DOACs had considerably lower risks of stroke/systemic embolism (adjusted hazard ratio [aHR] 0.29; 95% CI, 0.09-0.97) and any ischemia (aHR, 0.42; 95% CI, 0.22-0.79), but had comparable risks of major bleeding (aHR, 0.99; 95% CI, 0.34-2.92) and any bleeding (aHR, 0.74; 95% CI, 0.50-1.09) than warfarin. Apixaban was linked to considerably lower risks of any ischemia (aHR, 0.13; 95% CI, 0.04-0.48) and any bleeding (aHR, 0.53; 95% CI, 0.28-0.99) than warfarin. CONCLUSION: Among patients with AF and AKD, DOACs were linked to a lower risk of ischemic events, and apixaban was linked to a lower risk of any ischemia and any bleeding than warfarin.
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Hsu et al. (2023) conducted a cohort in Atrial fibrillation and advanced kidney disease (n=1,011). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Hospitalization for stroke/systemic embolism (HR 0.29, 95% CI 0.09-0.97, p=0.0439). DOACs significantly reduced the risk of stroke or systemic embolism (HR 0.29) compared to warfarin in patients with atrial fibrillation and advanced kidney disease.
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