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- Title
Impact of baseline renal function on the efficacy and safety of different Anticoagulants in Atrial Fibrillation Patients – A cohort study.
- Authors
Lee, Wei-Chieh; Liao, Ting-Wei; Fang, Hsiu-Yu; Wu, Po-Jui; Fang, Yen-Nan; Chen, Huang-Chung; Lin, Yu-Sheng; Chang, Shang-Hung; Liu, Ping-Yen; Chen, Mien-Cheng
- Abstract
Background: Vitamin K antagonists and different direct oral anticoagulants (DOACs) have different renal clearance rates. However, the impact of different stages of chronic renal impairment on the efficacy and safety of warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in atrial fibrillation (AF) patients remains unclear. Methods: This study enrolled AF patients from the Chang Gung Research Database. The study endpoints included thromboembolic events, major/fatal bleeding, gastrointestinal (GI) bleeding and intracranial hemorrhage (ICH). The risks of time to study endpoints between groups were compared using a Cox proportional hazards regression model with adjustment. Results: This study enrolled 3525 patients with moderate renal impairment (30 ≤ creatinine clearance (CrCl) < 60 mL/min), 2846 patients with mild renal impairment (60 ≤ CrCl < 90 mL/min) and 1153 patients with CrCl ≥ 90 mL/min. Over the 3.3 ± 0.9 years follow-up period, the cumulative thromboembolic events rates and the cumulative event rates of major/fatal bleeding and ICH did not differ among the warfarin and different DOAC groups at different stages of chronic renal impairment. The annual incidences of thromboembolic events, major/fatal bleeding, GI bleeding, and ICH were similar among the warfarin and different DOAC groups at different stages of renal impairment. Conclusion: There did not appear to be major differences in bleeding or thromboembolic risk compared to warfarin in AF patients across a range of degree of renal failure when appropriate dose reductions of the DOACs are made.
- Subjects
TAIWAN; HEMORRHAGE risk factors; THROMBOEMBOLISM prevention; CHRONIC kidney failure; PYRIDINE; KIDNEY function tests; WARFARIN; GASTROINTESTINAL hemorrhage; INTRACRANIAL hemorrhage; ATRIAL fibrillation; ANTICOAGULANTS; BENZIMIDAZOLES; RIVAROXABAN; DESCRIPTIVE statistics; LONGITUDINAL method; VITAMIN K; CREATININE; CHEMICAL inhibitors; DISEASE risk factors
- Publication
Thrombosis Journal, 2022, Vol 20, Issue 1, p1
- ISSN
1477-9560
- Publication type
Article
- DOI
10.1186/s12959-022-00423-w