Direct oral anticoagulants versus warfarin in patients with non-valvular atrial fibrillation and CKD G3-G5D

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Welander, FridaUmeå universitet,Institutionen för folkhälsa och klinisk medicin,Umeå Univ, Dept Publ Hlth & Clin Med, Dept Res & Dev Sundsvall, Umeå, Sweden. (author)

Direct oral anticoagulants versus warfarin in patients with non-valvular atrial fibrillation and CKD G3-G5D

Article/chapterEnglish2023

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2023-01-05
Oxford University Press,2023
electronicrdacarrier

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LIBRIS-ID:oai:DiVA.org:umu-214743
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-214743URI
https://doi.org/10.1093/ckj/sfad004DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-522491URI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Background: The use of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD) including dialysis is growing. Several studies have shown favorable results of DOAC compared with warfarin regarding bleeding risk but no difference in stroke protection. However, these studies had poor time in therapeutic range (TTR), in the warfarin comparison group.Methods: This was a Swedish national cohort study investigating the risk of ischemic stroke and major bleeding on DOAC compared with warfarin in patients with NVAF, glomerular filtration rate category 3-5D (G3-G5D), kidney transplant recipients excluded, between 2009 and 2018. Data extracted from high-quality national healthcare registries including the Swedish Renal Registry, AuriculA (the Swedish national quality register for AF and anticoagulation) and The Stroke Register.Results: At enrolment, of 2453 patients 59% were treated with warfarin (mean TTR 67%) and 41% with DOAC. Overall, 693 (28.3%) had G3, 1113 (45.4%) G4, 222 (9.1%) G5 and 425 (17.3%) G5D. DOAC compared with warfarin showed lower hazard of major bleeding [hazard ratio 0.71 (95% confidence interval 0.53-0.96)] but no difference in ischemic stroke risk. Mortality was increased during DOAC treatment [1.24 (1.01-1.53)], presumably not a causal association since fewer fatal bleedings occurred on DOAC.Conclusions: DOAC treatment, compared with warfarin, is associated with almost 30% lower risk of bleeding in patients with NVAF and CKD G3-G5D. The stroke risk is comparable between the treatments. This is the first study comparing DOAC and well-managed warfarin (TTR 67%) in advanced CKD. Ongoing and planned randomized controlled trials need to confirm the possible benefit of DOAC.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng
anticoagulants
atrial fibrillation
chronic kidney disease
dialysis

Added entries (persons, corporate bodies, meetings, titles ...)

Renlund, Henrik,1979-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)henre358 (author)
Dimény, EmökeUmeå universitet,Institutionen för folkhälsa och klinisk medicin,Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden.(Swepub:umu)emdi0006 (author)
Holmberg, Henrik,1976-Umeå universitet,Institutionen för epidemiologi och global hälsa,Umeå Univ, Dept Epidemiol & Global Hlth, Umeå, Sweden.(Swepub:umu)hekhog02 (author)
Själander, AndersUmeå universitet,Institutionen för folkhälsa och klinisk medicin,Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden.(Swepub:umu)anssjr90 (author)
Umeå universitetInstitutionen för folkhälsa och klinisk medicin (creator_code:org_t)

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In:Clinical Kidney Journal: Oxford University Press16:5, s. 835-8442048-85052048-8513

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