For patients wtih atrial fibrillation, AKI risk lower with oral anticoagulant vs warfarin
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For patients with atrial fibrillation, the risk for AKI was lower in those who were prescribed a direct oral anticoagulant than in those prescribed warfarin.
Findings from the population-based cohort study, conducted in Ontario, were published in the Clinical Journal of the American Society of Nephrology.
“Anticoagulant related nephropathy was first described in warfarin users and manifest by glomerular hemorrhage and tubular obstruction,” Ziv Harel, MD, MSC, and colleagues wrote. “Subsequent reports of anticoagulant related nephropathy have documented similar pathological findings among direct oral anticoagulant (DOAC) users, despite a putatively lower risk of bleeding compared to warfarin.”
For the study, Harel and colleagues assessed AKI risk in 20,863 patients aged 66 years and older who were prescribed dabigatran, rivaroxaban or apixaban between Jan. 1, 2009, and March 31, 2017. All patients had been diagnosed with AF within 5 years before initiating the medication.
The primary outcome of the study was a hospital encounter with AKI, with researchers focusing on the association between AKI and the prescribed medication.
Researchers observed that the weighted incidence of AKI was consistently lower in patients prescribed DOACs compared with those prescribed warfarin. Specific findings showed dabigatran conferred an AKI incident rate of 6.4 per 100 patient-years vs. 10.2 per 100 patient-years with warfarin; rivaroxaban conferred an incident rate of 9.1 per 100 patient-years vs. 11.1 per 100 patient-years with warfarin; and apixaban conferred an incident rate of 11.1 per 100 patient-years vs. 14.2 per 100 patient-years with warfarin.
According to the researchers, clinicians should always consider the risk for AKI when choosing an anticoagulant for their patients with AF, with DOACs now potentially offering a more ideal option for at-risk patients. Apixaban in particular was associated with a 50% reduction in the risk of AKI compared with warfarin among patients with a baseline eGFR of less than 30 mL/min/1.73 m2, the researchers noted.
“DOACs were associated with a lower risk of AKI compared to warfarin, a finding that was present even in those with underlying chronic kidney disease,” Harel and colleagues wrote. “These findings suggest that some DOACs, may have an acceptable safety profile in patients with advanced CKD and may become a suitable alternative to warfarin in this population.”
Editor's note: The title of this article was changed on Sept. 20, 2021 from "AKI risk lower in patients taking oral anticoagulant vs warfarin" to "For patients with atrial fibrillation, AKI risk lower with oral anticoagulant vs warfarin."
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