DOACs were associated with a lower risk of the primary composite efficacy outcome compared to warfarin (HR 0.84; 95% CI 0.74-0.95).
Observational (n=18,980)
Yes
Do DOACs or OAC improve efficacy and safety outcomes compared to warfarin or no anticoagulation in patients with atrial fibrillation and chronic kidney disease?
In patients with AF and CKD, DOACs are more effective and safer than warfarin, supporting their use as the preferred anticoagulant in this high-risk population.
Effect estimate: HR 0.84 (95% CI 0.74-0.95)
BACKGROUND: Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) face an increased risk of both thromboembolic and bleeding events, making anticoagulation management challenging. OBJECTIVE: This study aimed to compare the efficacy and safety of direct oral anticoagulants (DOACs), warfarin, and no oral-anticoagulation (OAC) in patients with AF and CKD. METHODS: Using 18,980 AF patients with CKD from Clalit database, we compared OAC versus no-OAC, and DOACs versus warfarin. Primary endpoints were composite-safety (intracranial-hemorrhage (ICH), gastrointestinal-bleeding) and efficacy (ischemic-stroke, myocardial-infarction (MI), embolism, and all-cause mortality). RESULTS: OAC therapy was associated with lower risk of the primary composite efficacy outcome compared with no-OAC (HR-0.57, 95% CI;0.52-0.62), driven by reduced all-cause mortality (HR-0.32, 95% CI;0.29-0.36), with no significant differences in thromboembolic events, or bleeding outcomes. In the comparison of DOACs versus warfarin, warfarin was associated with higher rates of composite bleeding (HR-0.67, 95% CI;0.5-0.89) and ICH (HR-0.51, 95% CI;0.32-0.8). DOACs were associated with a lower risk of the primary composite efficacy outcome (HR-0.84, 95% CI;0.74-0.95), with no significant differences in ischemic stroke. Among appropriately anticoagulated patients, safety differences between DOACs and warfarin were no longer significant (composite-bleeding HR-0.87, 95%;CI 0.52-1.47); however, DOACs remained associated with fewer primary efficacy events (HR-0.75, 95% CI;0.60-0.94). CONCLUSIONS: In patients with AF and CKD, OAC therapy improved efficacy outcomes without increasing bleeding risk. DOACs were more effective and safer than warfarin, supporting their use as the preferred anticoagulant in this high-risk population. Appropriate dosing and therapeutic monitoring are essential to maximize benefits and minimize bleeding complications.
Talmor‐Barkan et al. (Mon,) conducted a observational in Atrial fibrillation and chronic kidney disease (n=18,980). DOACs vs. Warfarin was evaluated on Composite efficacy (ischemic stroke, myocardial infarction, embolism, and all-cause mortality) (HR 0.84, 95% CI 0.74-0.95). DOACs were associated with a lower risk of the primary composite efficacy outcome compared to warfarin (HR 0.84; 95% CI 0.74-0.95).