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Renal function in atrial fibrillation patients switched from warfarin to a direct oral anticoagulant

Anum S Minhas1, Qingmei Jiang2, Xiaokui Gu2

  • 1Department of Internal Medicine, University of Michigan Medical Center, 2F208 UH , 1500 E. Medical Center Dr., SPC 5052, Ann Arbor, MI, 48109-5052, USA. aminhas@umich.edu.

Journal of Thrombosis and Thrombolysis
|May 25, 2016
PubMed

Insights

Direct oral anticoagulants (DOACs) require careful kidney function monitoring in atrial fibrillation patients. Many patients with changing renal function did not receive appropriate DOAC dose adjustments, highlighting a critical care gap.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) are increasingly used for stroke prevention in atrial fibrillation, offering an alternative to warfarin.
  • Kidney function is a crucial factor in DOAC elimination and dosing.
  • Previous studies have not fully elucidated renal function changes and dosing implications in patients switching from warfarin to DOACs.

Purpose of the Study:

  • To assess changes in renal function among atrial fibrillation patients transitioned from warfarin to DOAC therapy.
  • To evaluate the adherence to recommended DOAC dosing adjustments based on renal function.
  • To identify potential gaps in monitoring and dose management for DOACs in this patient population.

Main Methods:

  • Retrospective analysis of a multicenter cohort from the Michigan Anticoagulation Quality Improvement Initiative (MAQI2).
  • Inclusion of atrial fibrillation patients who switched from warfarin to a DOAC between 2009 and 2014 with at least two creatinine measurements.
  • Assessment of compliance with FDA-recommended dosing guidelines based on baseline and fluctuating renal function (creatinine clearance).

Main Results:

  • Of 189 patients, 34 (18.0%) had baseline creatinine clearance <50 mL/min, and 23 (12.2%) experienced significant renal function fluctuations.
  • Among those with renal function changes, only 1 of 6 (26.1%) patients received an appropriate DOAC dose adjustment.
  • Conversely, 15 patients had dose changes without documented renal function changes to justify them.

Conclusions:

  • While most atrial fibrillation patients exhibit stable renal function after switching to DOACs, a significant proportion experience fluctuations.
  • The majority of patients with indicated renal function changes did not receive appropriate DOAC dose adjustments.
  • Close monitoring of renal function and timely, accurate dose adjustments are essential as DOAC utilization expands.
Keywords:
AnticoagulantsApixabanDabigatranRenal insufficiencyRivaroxaban

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