Direct oral anticoagulants versus warfarin among atrial fibrillation patients with chronic kidney disease

Direct oral anticoagulants appear to be as likely as warfarin to prevent all strokes and systemic embolic events without increasing major bleeding events among atrial fibrillation patients with kidney impairment.

The quality of evidence is downgraded by imprecise results (few outcome events and wide confidence intervals).

Summary

A Cochrane review included 5 studies with a total of 12 545 subjects with atrial fibrillation (AF) and chronic kidney disease (CKD). The included studies compared direct oral anticoagulants (DOAC) (apixaban, dabigatran, edoxaban, and rivaroxaban) and dose-adjusted warfarin. Study duration ranged from 1.8 to 2.8 years. The large majority of participants included were CKD stage G3 (n=12 155), and a small number were stage G4 (n=390). CKD is classified into stage 1 (eGFR ≥ 90 mL/min); stage 2 (60 to 89 mL/min); stage 3a (45 to 59 mL/min); stage 3b (30 to 44 mL/min); stage 4 (15 to 29 mL/min); and stage 5 (< 15 mL/min).

DOAC appeared to probably reduce the incidence of stroke and systemic embolism events compared to warfarin (table ). No difference was observed in myocardial infarction and all-cause mortality. There were no statistically significant differences in major bleeding, minor bleeding, gastrointestinal bleeding, or intracranial haemorrhage.

Clinical comments

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Ədəbiyyat

1. Kimachi M, Furukawa TA, Kimachi K et al. Direct oral anticoagulants versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation patients with chronic kidney disease. Cochrane Database Syst Rev 2017;(11):CD011373.