Direct oral anticoagulants correlate with reduced kidney failure risk
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Compared with warfarin, direct oral anticoagulants correlated with a reduced risk for kidney failure and declined kidney function among patients with nonvalvular atrial fibrillation, according to a retrospective study.
“Direct oral anticoagulants (DOACs) have progressively replaced vitamin K antagonists (VKAs) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). DOACs cause fewer bleeding complications, but their other advantages, particularly related to kidney outcomes, remain inconclusive,” Marco Trevisan, PhD, from the department of medical epidemiology and biostatistics at Campus Solna at Karolinska Institutet, and colleagues wrote. They added, “The relative safety of anticoagulation with [DOACs] or [VKAs] like warfarin remains inconclusive, particularly with regard to outcomes related to kidney disease on injury.”
In a retrospective cohort study, researchers examined the data of 32,699 Swedish patients enrolled in the Stockholm Creatinine Measurements (SCREAM) project, all of whom were diagnosed with nonvalvular AF between 2011 and 2018. A total of 18,323 patients started DOAC treatment after their diagnosis and 14,376 started VKA treatment.
With the start of DOAC or VKA treatment serving as the exposures, researchers considered chronic kidney disease progression and AKI the primary outcomes of the study.
Using propensity score weighted Cox regression, researchers balanced 50 baseline confounders while comparing the two treatments.
Analyses revealed the adjusted HR for DOAC vs. VKA was 0.87 for the risk for CKD progression and 0.88 for AKI. Researchers identified HRs of 0.77 for major bleeding, 0.93 for the composite of stroke and systemic embolism, and 1.04 for death.
When limiting patients at high risk for thromboembolic events and censoring follow up at treatment discontinuation or change in type of anticoagulation, researchers observed similar results across subgroups of age, sex and baseline eGFR.
“[W]e observed that initiation of a DOAC compared with warfarin was associated with a lower risk [for] the composite of kidney failure and sustained 30% decline in kidney function, as well as a lower risk [for] occurrence of [AKI]. In agreement with trial evidence, DOAC versus warfarin treatment was associated with a lower risk [for] major bleeding but a similar risk [for] the composite of stroke, systemic embolism or death,” Trevisan and colleagues wrote. “Collectively, these findings add to the emerging evidence on the safety and effectiveness of DOAC administered for [AF].”
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