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Association of different oral anticoagulants use with renal function worsening in patients with atrial fibrillation: A multicentre cohort study
Author(s) -
Pastori Daniele,
Ettorre Evaristo,
Lip Gregory Y.H.,
Sciacqua Angela,
Perticone Francesco,
Melillo Francesco,
Godino Cosmo,
Marcucci Rossella,
Berteotti Martina,
Violi Francesco,
Pignatelli Pasquale,
Saliola Mirella,
Menichelli Danilo,
Casciaro Marco Antonio,
Menafra Vito
Publication year - 2020
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14350
Subject(s) - medicine , dabigatran , apixaban , atrial fibrillation , renal function , interquartile range , rivaroxaban , odds ratio , confidence interval , warfarin , prospective cohort study , gastroenterology
Aims To investigate the decline of estimated glomerular filtration rate (eGFR) in patients with atrial fibrillation (AF) treated with vitamin K antagonists (VKAs) or non‐VKA oral anticoagulants (NOACs). Methods Multicentre prospective cohort study including 1667 patients with nonvalvular AF. The eGFR was assessed by the CKD‐EPI formula at baseline and during follow‐up. The primary endpoint of the study was the median annual decline of eGFR according to VKA (n = 743) or NOAC (n = 924) use. As secondary endpoints, we analysed the transition to eGFR <50 mL/min/1.73 m 2 and the eGFR class worsening. Results Median age was 73.7 ± 9.1 years and 43.3% were women. VKA‐treated patients showed an eGFR decline of −2.11 (interquartile range [IQR] –5.68/−0.62), which was −0.27 (IQR –9.00/4.54, P < 0.001 vs VKAs), −1.21 (IQR –9.98/4.02, P = 0.004 vs VKAs) and −1.32 (IQR –8.70/3.99, P = 0.003 vs VKAs) in patients on dabigatran, rivaroxaban and apixaban, respectively. Transition to eGFR <50 mL/min/1.73 m 2 was lower in dabigatran‐ and apixaban‐treated patients: odds ratio (OR) 0.492, 95% confidence interval (CI) 0.298‐0.813, P = 0.006 and OR 0.449, 95% CI 0.276‐0.728, P = 0.001, respectively. A lower rate of eGFR class worsening was found in all groups of NOACs compared to VKAs. No difference between full and reduced dose of NOAC was found. Subgroup analysis showed that the association between NOAC and eGFR changes was markedly reduced in diabetic patients. Conclusion Patients prescribed NOACs showed a lower decline of renal function compared to those prescribed VKAs. This effect was partially lost in patients with diabetes.