Efficacy and safety of oral anticoagulants according to kidney function among patients with atrial fibrillation

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Limited data exists on direct oral anticoagulants (DOACs) in patients with severely reduced kidney function.
• Randomized controlled trials often exclude these patients, necessitating real-world evidence.

Purpose of the Study:

• To evaluate the safety and efficacy of DOACs across different kidney function subgroups.
• To compare the risk of stroke/thromboembolism and major bleeding among various oral anticoagulants.

Main Methods:

• Utilized Danish nationwide registers and laboratory databases for patient data.
• Included patients with atrial fibrillation initiated on oral anticoagulants (OACs) with available creatinine levels.
• Followed patients for 2 years to assess stroke/thromboembolism (TE) and major bleeding events.

Main Results:

• No significant differences in stroke/TE risk were observed between OACs.
• Apixaban demonstrated a lower 2-year risk of major bleeding compared to vitamin K antagonists (VKAs).
• The bleeding risk reduction with apixaban was more pronounced in patients with reduced kidney function.

Conclusions:

• DOACs offer comparable stroke/TE prevention regardless of kidney function.
• Apixaban shows a significant reduction in major bleeding risk versus VKAs, particularly in patients with impaired renal function.
• Apixaban demonstrated superior safety regarding bleeding compared to dabigatran and rivaroxaban in patients with moderate kidney dysfunction.