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June 7, 2026Open Access

The Renal Impact of Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis

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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?

Population

302,071 AF patients across 13 studies

Comparison

DOACs vs VKAs

Design

Systematic review and meta-analysis

Follow-up

Mean 2.3 years per patient

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).

Authors

ΑΑΑναστασία Θ. Αδάμου

Discussion

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Overview

Supports DOAC preference over VKAs in AF to lower renal decline risk; extends meta-analytic data on kidney outcomes.

Key Points

  • To assess the comparative effects of direct oral anticoagulants and vitamin K antagonists on renal function in patients with atrial fibrillation.
  • Systematic review and meta-analysis following PRISMA guidelines
  • Comprehensive search in PubMed/MEDLINE and EMBASE
  • Included studies assessing renal function outcomes in AF patients on DOACs or VKAs.
  • DOACs associated with lower risk of 30% eGFR reduction (HR:0.72, 95%CI:0.59–0.88)
  • Lower risk of progression to stage five CKD (HR:0.49, 95%CI:0.37–0.64)
  • Lower risk of doubling serum creatinine (HR:0.50, 95%CI:0.42–0.61).

Study Design

Type

Meta-Analysis (n=302,071)

Structured PICO

Do direct oral anticoagulants (DOACs) reduce the risk of renal function deterioration compared to Vitamin K antagonists (VKAs) in patients with atrial fibrillation?

P
Population
302,071 patients with atrial fibrillation treated with DOACs or VKAs, followed for a mean of 2.3 years per patient.
I
Intervention
Direct oral anticoagulants (DOACs) as a class (including apixaban, dabigatran, and rivaroxaban)
C
Comparator
Vitamin K antagonists (VKAs)
O
Outcome
30% estimated glomerular filtration rate (eGFR) decline, progression to stage five chronic kidney disease (CKD) and doubling of serum creatininesurrogate

Main Result

Hazard Ratio: 0.72 (95% CI 0.59–0.88)

In patients with atrial fibrillation, the use of DOACs is associated with a significantly delayed deterioration of renal function compared to vitamin K antagonists.

Cite This Study

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).

synapsesocial.com/papers/6a250be87def13d035e1be18https://doi.org/10.26262/heal.auth.ir.373661
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