Key result
Direct oral anticoagulants, with the exception of edoxaban, are associated with a lower risk of acute kidney injury compared to warfarin in patients with non-valvular atrial fibrillation.
Why the study?
It remained unclear whether DOAC users with non-valvular atrial fibrillation have a lower risk of acute kidney injury compared to warfarin users.
Does direct oral anticoagulants reduce acute kidney injury in patients with non-valvular atrial fibrillation compared to vitamin K antagonists?
Systematic Review
Does direct oral anticoagulants reduce acute kidney injury in patients with non-valvular atrial fibrillation compared to vitamin K antagonists?
Direct oral anticoagulants (except edoxaban) are generally associated with a lower risk of acute kidney injury compared to warfarin in patients with non-valvular atrial fibrillation, though this benefit remains uncertain in those with severe renal dysfunction.
May inform DOAC selection over warfarin to lower AKI risk in NVAF; leaves open effects in severe CKD pending RCTs.
Background: Patients with atrial fibrillation (AF) are routinely prescribed oral anticoagulants to prevent thromboembolism. Concerns regarding the efficacy and safety of oral anticoagulants, such as vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs), arise for patients with non-valvular atrial fibrillation (NVAF) because of their widespread use in clinical practice. Even though there have been an abundance of studies on this topic, it is still not clear if DOAC users with NVAF have a lower risk of acute kidney injury (AKI) than warfarin users. Methods and results: We conducted electronic searches in PubMed, Embase, and the Cochrane Library to identify relevant studies for this systematic review. We included randomized clinical trials and observational studies that reported on the incidence rate, hazard ratio (HR), and 95% confidence interval (95% CI) of AKI in patients using oral anticoagulants. This systemic review included six observational studies and four randomized clinical trials (RCT). The overall results showed that DOACs were associated with a lower AKI risk than warfarin. However, for NVAF patients with severe renal dysfunction, DOACs may not have a reduced risk of AKI compared to warfarin. Conclusion: The overall results suggest that, except for edoxaban, patients using DOACs may experience a reduced risk of AKI. However, it is uncertain whether this is also the case for patients with severe renal dysfunction. Further research is needed to confirm the effect of DOACs on this population.
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Ren et al. (2023) conducted a systematic review in Non-valvular atrial fibrillation. Direct oral anticoagulants vs. Vitamin K antagonists (warfarin) was evaluated on Acute kidney injury. Direct oral anticoagulants, with the exception of edoxaban, are associated with a lower risk of acute kidney injury compared to warfarin in patients with non-valvular atrial fibrillation.
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