NOACs Show Lower Risk of Adverse Renal Outcomes in A-Fib
TUESDAY, Nov. 21, 2017 -- For patients with atrial fibrillation (AF), non-vitamin K antagonist oral anticoagulants (NOACs) are associated with lower risks of adverse renal outcomes than warfarin, according to a study published in the Nov. 28 issue of the Journal of the American College of Cardiology.
Using data for 9,769 patients with nonvalvular AF, Xiaoxi Yao, Ph.D., from the Mayo Clinic in Rochester, Minn., and colleagues compared four oral anticoagulant agents (apixaban, dabigatran, rivaroxaban, and warfarin) for their effects on four renal outcomes.
The researchers found that at the end of two years, the cumulative risks were 24.4, 4.0, 14.8, and 1.7 percent for ≥30 percent decline in estimated glomerular filtration rate (eGFR), doubling of serum creatinine, acute kidney injury (AKI), and kidney failure, respectively. Compared with warfarin, pooled NOACs correlated with reduced risk of ≥30 percent decline in eGFR, doubling of serum creatinine, and AKI (hazard ratios, 0.77, 0.62, and 0.68, respectively). Comparing each NOAC with warfarin, dabigatran correlated with reduced risks of ≥30 percent decline in eGFR and AKI; rivaroxaban correlated with reduced risks of ≥30 percent decrease in eGFR, doubling of serum creatinine, and AKI; while there was no significant correlation for apixaban with any of the renal outcomes.
"Renal function decline is common among patients with AF treated with oral anticoagulant agents," the authors write. "NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin."
One author disclosed financial ties to the pharmaceutical industry; several pharmaceutical and medical device companies provided funding for the study.
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Posted: November 2017