Open AccessComparative efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease
Author(s) -
В. С. Горбатенко,
А. С. Герасименко,
О. В. Шаталова
Publication year - 2020
Publication title -
kardiologiâ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.159
H-Index - 16
eISSN - 2412-5660
pISSN - 0022-9040
DOI - 10.18087/cardio.2020.9.n1178
Subject(s) - apixaban , rivaroxaban , dabigatran , medicine , atrial fibrillation , relative risk , stroke (engine) , confidence interval , renal function , creatinine , kidney disease , randomized controlled trial , cardiology , warfarin , mechanical engineering , engineering
Aim To compare efficacy and safety of direct oral anticoagulants (DOACs) for prevention of stroke in patients with nonvalvular atrial fibrillation and reduced creatinine clearance. Material and methods Systematic search for literature and indirect comparison of DOACs were performed. Results The indirect comparison included five randomized clinical trials. The DOACs were comparable by the efficacy of preventing stroke and systemic embolism. The safety profiles had differences. Apixaban significantly decreased the relative risk of major bleeding compared to rivaroxaban by 27 % (relative risk (RR) 0.73; 95 % confidence interval (CI): 0.55–0.98). The apixaban advantage was even greater in the group of patients with a creatinine clearance <50 ml/min: RR was reduced by 48 % compared to rivaroxaban (RR=0.52; 95 % CI: 0.32–0.84), by 50 % compared to dabigatran 300 mg/day (RR=0.50; 95 % CI: 0.31–0.81), and by 48 % compared to dabigatran 220 mg/day (RR=0.52; 95 % CI: 0.32–0.85) Conclusion The indirect comparison of DOACs showed that their efficacy was comparable. With respect of safety, apixaban is the preferrable DOAC for patients with atrial fibrillation and creatinine clearance below 50 ml/min.