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Arrhythmias & electrophysiologyCohort study

Long-term comparative efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and chronic kidney disease: A nationwide observational study

Heart RhythmPublished

  • Nationwide observational study
  • Clalit database
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Authors' conclusion

In patients with AF and CKD, OAC therapy improved efficacy outcomes without increasing bleeding risk. DOACs were more effective and safer than warfarin, supporting their use as the preferred anticoagulant in this high-risk population. Appropriate dosing and therapeutic monitoring are essential to maximize benefits and minimize bleeding complications.

Study context

Population
Patients with atrial fibrillation (AF) and chronic kidney disease (CKD)AF patients with CKD
Participants
18,980 patients
Exposure
Oral anticoagulation (OAC) vs no OAC and direct oral anticoagulants (DOACs) vs warfarin
Outcome
Composite-safety (intracranial hemorrhage, gastrointestinal bleeding) and efficacy (ischemic stroke, myocardial infarction, embolism, all-cause mortality)

Main finding

As reported in the abstract

Hazard ratio

0.57

95% CI 0.52–0.62

Primary composite efficacy outcome (ischemic stroke, myocardial infarction, embolism, all-cause mortality) — OAC vs no OAC
HR 0.57 (95% CI 0.52–0.62)

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
All-cause mortality · reduced with OAC0.32 (0.29–0.36)
Composite bleeding and primary efficacy events among appropriately anticoagulated patients (subgroup) — DOACs vs warfarin · composite bleeding; no longer significant0.87 (0.52–1.47)
Composite bleeding and primary efficacy events among appropriately anticoagulated patients (subgroup) — DOACs vs warfarin · primary efficacy events; fewer with DOACs0.75 (0.60–0.94)

Thromboembolic events and bleeding outcomes (OAC vs no OAC)

No significant differences

Ischemic stroke (DOACs vs warfarin)

No significant differences

Safety

OutcomeHR (95% CI)
Intracranial hemorrhage · higher rates with warfarin0.51 (0.32–0.8)

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Long-term comparative efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and chronic kidney disease: A nationwide observational study. Heart Rhythm. Published 23 June 2026. doi:10.1016/j.hrthm.2026.06.020
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Summarised from the published abstract; every number is checked against it