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Published on: February 26, 2013
The impact on renal function after long-term use of anticoagulants in atrial fibrillation patients
Wei-Chieh Lee1,2, Pai-Wei Lee3, Po-Jui Wu2
1Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Direct oral anticoagulants (DOACs) showed a lower incidence of acute kidney injury (AKI) compared to warfarin in atrial fibrillation (AF) patients. Long-term renal function decline was similar between DOACs and warfarin.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Oral anticoagulants are crucial for stroke prevention in atrial fibrillation (AF) patients with CHA2DS2VASc score ≥1.
- Warfarin and direct oral anticoagulants (DOACs) have different metabolic pathways affecting kidney function.
- The long-term impact of these anticoagulants on renal function in AF patients is not fully understood.
Purpose of the Study:
- To compare the effects of DOACs versus warfarin on renal function decline in a large cohort of AF patients.
- To evaluate the incidence of acute kidney injury (AKI) associated with long-term use of DOACs and warfarin.
- To assess the change in estimated glomerular filtration rate (eGFR) over time for patients on different anticoagulants.
Main Methods:
- A retrospective cohort study using the Chang Gung Research Database (2000-2018) included patients with nonvalvular AF.
- Propensity score matching was used to compare baseline and follow-up eGFR, and the change in eGFR between DOACs and warfarin.
- The primary endpoint was the incidence of acute kidney injury (AKI).
Main Results:
- The study included 3657 AF patients with a mean follow-up of 3.3 years.
- Warfarin was associated with a significantly higher incidence of AKI compared to DOACs, both before (9.2% vs. 5.2%) and after propensity score matching (8.9% vs. 4.4%).
- No significant difference in the change of eGFR was observed between the warfarin and DOAC groups post-matching (-1.27 vs. -1.94 mL/min/1.73 m²/year).
Conclusions:
- Long-term warfarin use in AF patients is linked to a higher risk of AKI compared to DOACs.
- The rate of renal function decline, as measured by eGFR change, did not significantly differ between warfarin and DOACs.
- DOACs represent a potentially safer alternative regarding kidney injury in AF patients requiring long-term anticoagulation.
Objective:
Long-term oral anticoagulant should be considered or recommended in patients with atrial fibrillation (AF) and CHA2DS2VASc score ≥ 1 for stroke prevention. Warfarin and different direct oral anticoagulants (DOACs) are metabolized differently by the kidney. The impact on renal function after long-term use of anticoagulants in the patients with AF remains unclear. This study aimed to compare DOACs and warfarin's impact on the decline in renal function from a large cohort with AF.
Methods:
This study included patients with nonvalvular AF from 2000 to 2018, mainly through the medical history (ICD code) of the Chang Gung Research Database. Baseline estimated glomerular filtration rate (eGFR), follow-up eGFR and the change in eGFR between 2-year eGFR and baseline eGFR were compared between different DOACs and warfarin after propensity score matching. The primary study endpoint was acute kidney injury (AKI).
Results:
3657 patients were enrolled in this study and the mean observation time was 3.3 ± 0.9 years. During the observation period, there was a significantly higher incidence of AKI during follow-up in the warfarin group than in the different DOAC groups before and after propensity score matching (before: warfarin vs. DOAC: 9.2% vs. 5.2%, p < 0.001; after: warfarin vs. DOAC: 8.9% vs. 4.4%, p < 0.001). There was no difference in the incidence of AKI between dabigatran group and anti-factor Xa inhibitor group after propensity score matching. The incidence of AKI was similar among rivaroxaban, apixaban and edoxaban groups after propensity score matching. The change in eGFR between 2-year eGFR and baseline eGFR did not differ between the warfarin and DOAC groups after propensity score matching (warfarin vs. DOAC: - 1.27 ± 20.32 vs. -1.94 ± 17.24 mL/min/1.73 m2, p = 0.461).
Conclusions:
During the mean observation time of 3.3 ± 0.9 years, warfarin was associated with a higher incidence of AKI compared with DOACs. The decline in renal function did not differ among warfarin and different DOAC groups.
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