Key result
Scoping review protocol maps DOACs versus warfarin outcomes across all stages of CKD in AF.
Why the study?
Although DOACs have favorable safety and effectiveness profiles compared with warfarin in the general AF population, evidence in patients with impaired renal function is heterogeneous, especially in advanced CKD stages and in those receiving renal replacement therapy.
Do direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran) improve safety and effectiveness outcomes compared to warfarin in adults with nonvalvular atrial fibrillation and chronic kidney disease (stages G1–G5, including dialysis)?
Do direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran) improve safety and effectiveness outcomes compared to warfarin in adults with nonvalvular atrial fibrillation and chronic kidney disease (stages G1–G5, including dialysis)?
Answers are grounded in this paper and cite their sources.
This scoping review protocol aims to map the heterogeneous evidence and identify knowledge gaps regarding the safety and effectiveness of direct oral anticoagulants versus warfarin across all stages of chronic kidney disease in patients with atrial fibrillation.
Introduction: Anticoagulation in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) represents a clinical challenge due to the simultaneous increase in thromboembolic and bleeding risks. Although direct oral anticoagulants (DOACs) have demonstrated favorable safety and effectiveness profiles compared with warfarin in the general population with AF, the evidence in patients with impaired renal function is heterogeneous, especially in advanced stages and in those receiving renal replacement therapy. Objective: To map and characterize the available scientific evidence on the safety and effectiveness of direct oral anticoagulants versus warfarin in adult patients with chronic kidney disease and atrial fibrillation, considering different stages of renal function, treatments, and clinical outcomes Methods: A scoping review will be conducted following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR recommendations. The literature search was conducted on November 9, 2026, in PubMed/MEDLINE, Scopus, and Web of Science, considering publications between January 2015 and November 2026. Comparative studies in adults with nonvalvular AF and CKD stages G1–G5, including patients on dialysis, will be included. Study selection will be carried out by independent reviewers using RAYYAN. Data will be extracted into Microsoft Excel and analyzed descriptively and thematically by CKD stage, DOAC used, dose, and safety and effectiveness outcomes. Expected results: Heterogeneous evidence is expected regarding comparisons of apixaban, rivaroxaban, edoxaban, and dabigatran versus warfarin, with differences in methodological designs, populations, and outcomes assessed. Lower representation of patients with advanced CKD and those on dialysis is anticipated, as is uncertainty about dosage regimens and clinical outcomes in these subgroups. The findings will help identify knowledge gaps and guide future research. Descriptors (MeSH): Atrial Fibrillation; Renal Insufficiency, Chronic; Anticoagulants; Warfarin; Stroke; Hemorrhage.
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María Paula Vásquez Bazurto (2026) conducted a review in Chronic kidney disease and atrial fibrillation. Direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran) vs. Warfarin was evaluated on Safety and effectiveness outcomes (including thromboembolic events/stroke and bleeding/hemorrhage). Direct oral anticoagulants versus warfarin in adults with AF and CKD stages G1–G5 are being mapped in a scoping review protocol (2015–2026) with no quantitative results yet reported.
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