Arrhythmias & electrophysiology
Kidney function and the comparative effectiveness and safety of direct oral anticoagulants vs. warfarin in adults with atrial fibrillation: a multicenter observational study
Authors' conclusion
DOAC use, compared with warfarin use, was associated with a lower or similar risk of all-cause death, ischaemic stroke, and transient ischaemic attack and also a lower or similar risk of major bleeding across all levels of kidney function.
Study context
- Population
- Adults with AF and a baseline estimated glomerular filtration rate (eGFR), Australia and Canada, 2011–18matched analysis
- Participants
- 74,542 adults
- Exposure
- DOAC vs warfarin, by eGFR category
- Outcome
- Composite of all-cause death, first hospitalization for ischaemic stroke or TIA (effectiveness); first hospitalization for major bleeding (safety)
- Follow-up
- Within 1 year from cohort entry
Methodological detailspooled analysis of five cohorts, propensity-score matched (1:1), multicentre
- Pooled analysis of five cohorts
- Propensity-score matched (1:1)
- Multicentre
Main finding
As reported in the abstract
All-cause death, ischaemic stroke or TIA, by eGFR (mL/min/1.73 m²) · 1 year
DOAC vs WarfarinPooled hazard ratio (95% CI)
eGFR ≥60
0.74(0.69–0.79)
eGFR 45-59
0.76(0.54–1.07)
eGFR 30-44
0.68(0.61–0.75)
eGFR <30
0.86(0.76–0.98)
Observational data: associations, not effects.
Safety
| Outcome | Pooled HR (95% CI) | |
|---|---|---|
| Major bleeding (intracranial, GI or other), by eGFR (mL/min/1.73 m²) · 1 yearDOACvs WarfarineGFR ≥60 · matched cohort | 0.75 (0.65–0.86) | |
| Major bleeding (intracranial, GI or other), by eGFR (mL/min/1.73 m²) · 1 yearDOACvs WarfarineGFR 45-59 · matched cohort | 0.81 (0.65–1.01) | |
| Major bleeding (intracranial, GI or other), by eGFR (mL/min/1.73 m²) · 1 yearDOACvs WarfarineGFR 30-44 · matched cohort | 0.82 (0.66–1.02) | |
| Major bleeding (intracranial, GI or other), by eGFR (mL/min/1.73 m²) · 1 yearDOACvs WarfarineGFR <30 · matched cohort | 0.71 (0.52–0.99) | |
| 0.512Pooled hazard ratio (log scale) |
Original publication
Kidney function and the comparative effectiveness and safety of direct oral anticoagulants vs. warfarin in adults with atrial fibrillation: a multicenter observational study. Eur Heart J Qual Care Clin Outcomes. Published 27 October 2022. doi:10.
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