Study on the Impact of Direct Oral Anticoagulants vs. Vitamin K Antagonists

A recent study by Marco Trevisan and team found that Direct oral anticoagulant (DOAC) use is associated with a lower risk of chronic kidney disease (CKD) progression, acute kidney injury (AKI), and major bleeding compared to vitamin K antagonists (VKA) use in patients with nonvalvular atrial fibrillation (AF), with no significant difference in the risk of death or the composite of stroke and systemic embolism. The findings were published in American Journal of Kidney Diseases.

Direct oral anticoagulants have become the preferred choice over vitamin K antagonists for stroke prevention in patients with nonvalvular AF due to their lower risk of bleeding complications. This study aimed to investigate the impact of DOACs and VKAs on kidney outcomes in patients with nonvalvular AF.

Study Details

The retrospective cohort study involved 32,699 Swedish patients with nonvalvular AF between 2011-2018. Patients were initiated on either DOAC or VKA treatment, and the primary outcomes were CKD progression and AKI. The secondary outcomes were death, major bleeding, and the composite of stroke and systemic embolism. Propensity score weighted Cox regression was used to balance 50 baseline confounders.

Findings

• DOAC use was associated with a lower risk of CKD progression, AKI, and major bleeding compared to VKA use.
• The adjusted hazard ratios (HRs) for DOAC versus VKA were 0.87 for CKD progression and 0.88 for AKI.
• No significant difference in the risk of death or the composite of stroke and systemic embolism between the two groups.
• Results were consistent across subgroups of age, sex, and baseline eGFR, and when patients were at high risk for thromboembolic events.

Reference

Trevisan, M., Hjemdahl, P., Clase, C. M., de Jong, Y., Evans, M., Bellocco, R., Fu, E. L., & Carrero, J. J. (2023). Cardiorenal Outcomes Among Patients With Atrial Fibrillation Treated With Oral Anticoagulants. In American Journal of Kidney Diseases (Vol. 81, Issue 3, pp. 307-317.e1). Elsevier BV. https://doi.org/10.1053/j.ajkd.2022.07.017