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Renal Outcomes in Anticoagulated Patients with Atrial Fibrillation.

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eMediNexus    04 December 2017

A new study published in Journal of the American College of Cardiology aimed to compare four oral anticoagulants (apixaban, dabigatran, rivaroxaban, and warfarin) for their effects on four renal outcomes: ≥30% decline in estimated glomerular filtration rate (eGFR); doubling of the serum creatinine level; acute kidney injury (AKI); and kidney failure. Here, 9,769 patients were identified, using a large U.S. administrative database linked to laboratory results, with non-valvular atrial fibrillation (AF), who were started on an oral anticoagulant agent between October 1, 2010 and April 30, 2016. The results revealed that the cumulative risk at the end of 2 years for each outcome was 24.4%, 4.0%, 14.8%, and 1.7% for ≥30% decline in eGFR, doubling of serum creatinine, AKI, and kidney failure, respectively. On the other hand, when the 3 non-vitamin K antagonist oral anticoagulants (NOACs) were pooled, they were associated with reduced risks of ≥30% decline in eGFR, doubling of serum creatinine and AKI compared to warfarin. While comparing each NOAC with warfarin, dabigatran was associated with lower risks of ≥30% decline in eGFR and AKI; rivaroxaban was associated with lower risks of ≥30% decline in eGFR, doubling of serum creatinine, and AKI. However, apixaban did not have a statistically significant relationship with any of the renal outcomes. Hence, it was inferred that renal function decline is common among patients with AF treated with oral anticoagulant agents. It was stated that NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.

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