Key result
Dabigatran was associated with a lower risk of composite cardiorenal events compared to warfarin in patients with atrial fibrillation, whereas rivaroxaban and edoxaban showed no significant protective effects.
Why the study?
DOACs may carry a lower risk of renal function decline compared to warfarin in patients with non-valvular AF, but comparative renal outcomes among specific DOACs and warfarin needed examination.
Do direct oral anticoagulants (dabigatran, rivaroxaban, edoxaban) reduce cardiorenal events compared to warfarin in adults with atrial fibrillation?
Cohort (n=2,203)
No
Do direct oral anticoagulants (dabigatran, rivaroxaban, edoxaban) reduce cardiorenal events compared to warfarin in adults with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
In patients with atrial fibrillation, dabigatran is associated with a significantly lower risk of cardiorenal events and renal function decline compared to warfarin, while rivaroxaban and edoxaban showed no significant renal protective effects.
Background Life-long oral anticoagulation therapy with warfarin or direct oral anticoagulants (DOACs) is the mainstay for stroke prevention in patients with non-valvular atrial fibrillation (AF). The DOACs might potentially have lower risk on decline in renal function than warfarin. The aim of this study was to examine the renal outcomes among rivaroxaban, edoxaban, dabigatran and warfarin. Method Using a clinical database from a single-center, this cohort study identified 2203 adults with AF who started anticoagulation therapy between July 1, 2013 and December 31, 2020. Inverse probability of treatment weighting was adopted to balance baseline characteristics among four groups. The primary outcome was a composite of cardiorenal outcomes, involving ≥ 30% decline in estimated glomerular filtration rate (eGFR), renal failure, cardiovascular death, and renal death. Other renal outcomes of interest including ≥ 30% decline in eGFR, doubling of serum creatinine, the incidence of acute kidney injury (AKI) and renal failure, were analyzed. Result We studied 595 patients on warfarin, who were compared to 244, 1070 and 289 patients on dabigatran, rivaroxaban and edoxaban, respectively. After propensity score weighting, dabigatran was associated with significantly lower risk of ≥ 30% decline in eGFR (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.497 to 0.951; p = 0.0237), doubling of serum creatinine (HR:0.49; 95% CI: 0.259 to 0.927; p = 0.0282), and the composite of cardiorenal outcomes (HR:0.67; 95% CI: 0.485 – 0.913; p = 0.0115) compared with warfarin. Rivaroxaban and edoxaban did not show statistically significant protective effects on any renal outcomes, compared to warfarin. Conclusion In this retrospective, single center study, patients treated with dabigatran had significantly reduced risk of decline in renal function and cardiorenal events, when compared to those treated with warfarin. In contrast, rivaroxaban and edoxaban were not associated with lower risk of AKI and renal failure when compared to warfarin.
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Wang et al. (2023) conducted a cohort in Non-valvular atrial fibrillation (n=2,203). Dabigatran vs. Warfarin was evaluated on Composite of cardiorenal outcomes (≥ 30% decline in eGFR, renal failure, cardiovascular death, and renal death) (HR 0.67, 95% CI 0.485-0.913, p=0.0115). Dabigatran was associated with a lower risk of composite cardiorenal events compared to warfarin in patients with atrial fibrillation, whereas rivaroxaban and edoxaban showed no significant protective effects.
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