Zou R, et al. - An appraisal was carried out of the safety and efficacy of anticoagulation therapy for atrial fibrillation (AF) associated with renal function. Additionally, researchers gauged the change in estimated glomerular filtration rate (eGFR) from baseline and compared the outcomes for patients with stable and worsening renal function. The findings disclosed a greater clinical benefit from direct oral anticoagulants (DOACs) than warfarin in terms of renal function. They correlated with a comparatively lower risk of stroke and major bleeding, along with lower eGFR. Hence, these agents presented as a better choice in patients with renal disease.

Methods

• Experts selected studies in which outcomes for direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban, or edoxaban) were compared with those for warfarin in AF patients with normal, mild or moderate renal function, with the exception of the severe one (creatinine clearance < 30).

Results

• Five clinical trials were scrutinized, involving 72,608 patients.
• Pooled analysis disclosed lower risk of stroke for DOACs than for warfarin among patients with mild renal impairment (Risk ratio, 0.79; 95% confidence interval, 0.68-0.91) and moderate renal impairment (0.80, 0.69-0.92).
• In patients with normal renal function, there were no major variations.
• DOACs illustrated a correlation with fewer major bleeds among patients with normal (0.77, 0.70-0.84), mild (0.86, 0.77-0.95), and moderate renal impairment (0.73, 0.65-0.82).
• A lower dosage was related to lower risk of major bleeding (0.75, 0.68-0.83) and higher risk of stroke or systemic embolism (1.28, 1.12-1.47), among those treated with DOACs.
• DOACs exhibited a tendency to be linked with a lower estimated glomerular filtration rate (eGFR) than warfarin even after 30 months.
• Prominent variations were reported in the risk of stroke (2.09, 1.64-2.68) and major bleeding (2.01, 1.66-2.42) between patients with stable and worsening renal function.