Key result
Direct oral anticoagulants were associated with a lower risk of 30% eGFR reduction compared to Vitamin K antagonists in patients with atrial fibrillation (HR 0.72; 95% CI 0.59-0.88).
Why the study?
Anticoagulant-related nephropathy has been documented with both warfarin and direct oral anticoagulants, prompting an evaluation of the comparative effect of DOACs versus VKAs on renal function deterioration in atrial fibrillation.
Do direct oral anticoagulants (DOACs) reduce the risk of renal function deterioration compared to Vitamin K antagonists (VKAs) in patients with atrial fibrillation?
Meta-Analysis (n=302,071)
Do direct oral anticoagulants (DOACs) reduce the risk of renal function deterioration compared to Vitamin K antagonists (VKAs) in patients with atrial fibrillation?
In patients with atrial fibrillation, the use of DOACs is associated with a significantly delayed deterioration of renal function compared to vitamin K antagonists.
Answers are grounded in this paper and cite their sources.
Supports DOAC preference over VKAs in AF to lower renal decline risk; extends meta-analytic data on kidney outcomes.
Background and Aims: The use of anticoagulants has been linked to anticoagulant-related nephropathy (ARN), a condition initially reported in patients treated with warfarin. However, cases have also been documented in patients receiving direct oral anticoagulants (DOACs). We conducted a systematic review and meta-analysis to assess the comparative effect of DOACs versus Vitamin K antagonists (VKAs) in renal function deterioration in atrial fibrillation (AF) population. Methods: According to the PRISMA reporting guidelines for systematic reviews and meta-analyses, we performed a comprehensive search in PubMed/MEDLINE and EMBASE (via Scopus), focusing on studies in AF patients treated with DOACs or VKAs and assessing their renal function over time. The studied outcomes were 30% estimated glomerular filtration rate (eGFR) decline, progression to stage five chronic kidney disease (CKD) and doubling of serum creatinine. Results: Among 4,566 records, 13 studies with 302,071 patients were included with an overall follow-up period of 701,421.5 patient years (mean: 2.3 years per patient). DOACs were associated with a lower risk of 30% eGFR reduction (HR:0.72, 95%CI:0.59–0.88), progression to stage five CKD (HR:0.49, 95%CI:0.37–0.64) and doubling of serum creatinine (HR:0.50, 95%CI:0.42–0.61). 30% eGFR reduction was also lower when apixaban, dabigatran and rivaroxaban were compared separately to VKAs, (HR:0.81, 95%CI:0.69–0.95), (HR: 0.61, 95% CI: 0.48–0.78) and (HR: 0.80, 95% CI: 0.70–0.92) respectively. There was no effect in progression to stage five CKD and doubling of serum creatinine, when apixaban was compared to VKAs. Conclusions: This systematic review and metanalysis of 13 studies and >300,000 patients with atrial fibrillation followed for an overall period of >700,000 patient years showed that the deterioration of renal function is delayed in patients treated with DOACs compared to VKAs.
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Αναστασία Θ. Αδάμου (2026) conducted a meta-analysis in Atrial fibrillation (n=302,071). Direct Oral Anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on 30% estimated glomerular filtration rate (eGFR) decline (HR 0.72, 95% CI 0.59-0.88). Direct oral anticoagulants were associated with a lower risk of 30% eGFR reduction compared to Vitamin K antagonists in patients with atrial fibrillation (HR 0.72; 95% CI 0.59-0.88).
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