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Renal safety of NOACs

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Dr Ramesh Hotchandani    04 December 2017

Renal function decline is common for atrial fibrillation patients on oral anticoagulants; however, dabigatran and rivaroxaban seem safer for the kidneys than warfarin, suggests new research published in the Journal of the American College of Cardiology.

The study compared four oral anticoagulant agents, including apixaban, dabigatran, rivaroxaban, and warfarin, for their effects on 4 renal outcomes: ≥30% decline in estimated glomerular filtration rate (eGFR), doubling of the serum creatinine level, acute kidney injury (AKI), and kidney failure. In all, 9,769 patients with nonvalvular AF who started taking an oral anticoagulant agent between October 1, 2010 and April 30, 2016 were identified making use of a large U.S. administrative database linked to laboratory results.

The cumulative risk at the end of 2 years for the outcomes was 24.4%, 4.0%, 14.8%, and 1.7% for ≥30% decline in eGFR, doubling of serum creatinine, AKI, and kidney failure, respectively. When the 3 non–vitamin K antagonist oral anticoagulant (NOACs) were pooled, they were found to be associated with reduced risks of ≥30% decline in eGFR, doubling of serum creatinine, and AKI, in comparison with warfarin. When each NOAC was compared with warfarin, dabigatran seemed to be 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; while apixaban did not show any statistically significant relationship with any of the renal outcomes.

Lifelong oral anticoagulation, with warfarin or NOACs, is indicated for stroke prevention in most patients with atrial fibrillation (AF). It seems that NOACs, especially dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.

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