Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis
Background Non‐vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non‐valvular atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin parti...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.019609 |
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| author | Patita Sitticharoenchai Kullaya Takkavatakarn Smonporn Boonyaratavej Kearkiat Praditpornsilpa Somchai Eiam‐Ong Paweena Susantitaphong |
| author_facet | Patita Sitticharoenchai Kullaya Takkavatakarn Smonporn Boonyaratavej Kearkiat Praditpornsilpa Somchai Eiam‐Ong Paweena Susantitaphong |
| author_sort | Patita Sitticharoenchai |
| collection | DOAJ |
| description | Background Non‐vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non‐valvular atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin particularly renal outcomes remain inconclusive. Methods and Results Electronic searches were conducted through Medline, Scopus, Cochrane Library databases, and ClinicalTrial.gov. Randomized controlled trials and observational cohort studies reporting incidence rates and hazard ratio (HR) of renal outcomes (including acute kidney injury, worsening renal function, doubling serum creatinine, and end‐stage renal disease) were selected. The random‐effects model was used to calculate pooled incidence and HR with 95% CI. Eighteen studies were included. A total of 285 201 patients were enrolled, 118 863 patients with warfarin and 166 338 patients with NOACs. The NOACs group yielded lower incidence rates of all renal outcomes when compared with the warfarin group. Patients treated with NOACs showed significantly lower HR of risk of acute kidney injury (HR, 0.70, 95% CI, 0.64–0.76; P<0.001), worsening renal function (HR, 0.83; 95% CI, 0.73–0.95; P=0.006), doubling serum creatinine (HR, 0.58; 95% CI, 0.41–0.82; P=0.002), and end‐stage renal disease (HR, 0.82; 95% CI, 0.78–0.86; P<0.001). Conclusions In non‐valvular atrial fibrillation, patients treated with NOACs have a lower risk of both acute kidney injury and end‐stage renal disease when compared with warfarin. |
| first_indexed | 2024-12-13T09:00:22Z |
| format | Article |
| id | doaj.art-65878b83abcd47b895acae222a502ff8 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T09:00:22Z |
| publishDate | 2021-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-65878b83abcd47b895acae222a502ff82022-12-21T23:53:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-04-0110710.1161/JAHA.120.019609Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysisPatita Sitticharoenchai0Kullaya Takkavatakarn1Smonporn Boonyaratavej2Kearkiat Praditpornsilpa3Somchai Eiam‐Ong4Paweena Susantitaphong5Division of Cardiology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial HospitalChulalongkorn University Bangkok ThailandDivision of Nephrology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial HospitalChulalongkorn University Bangkok ThailandDivision of Cardiology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial HospitalChulalongkorn University Bangkok ThailandDivision of Nephrology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial HospitalChulalongkorn University Bangkok ThailandDivision of Nephrology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial HospitalChulalongkorn University Bangkok ThailandDivision of Nephrology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial HospitalChulalongkorn University Bangkok ThailandBackground Non‐vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non‐valvular atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin particularly renal outcomes remain inconclusive. Methods and Results Electronic searches were conducted through Medline, Scopus, Cochrane Library databases, and ClinicalTrial.gov. Randomized controlled trials and observational cohort studies reporting incidence rates and hazard ratio (HR) of renal outcomes (including acute kidney injury, worsening renal function, doubling serum creatinine, and end‐stage renal disease) were selected. The random‐effects model was used to calculate pooled incidence and HR with 95% CI. Eighteen studies were included. A total of 285 201 patients were enrolled, 118 863 patients with warfarin and 166 338 patients with NOACs. The NOACs group yielded lower incidence rates of all renal outcomes when compared with the warfarin group. Patients treated with NOACs showed significantly lower HR of risk of acute kidney injury (HR, 0.70, 95% CI, 0.64–0.76; P<0.001), worsening renal function (HR, 0.83; 95% CI, 0.73–0.95; P=0.006), doubling serum creatinine (HR, 0.58; 95% CI, 0.41–0.82; P=0.002), and end‐stage renal disease (HR, 0.82; 95% CI, 0.78–0.86; P<0.001). Conclusions In non‐valvular atrial fibrillation, patients treated with NOACs have a lower risk of both acute kidney injury and end‐stage renal disease when compared with warfarin.https://www.ahajournals.org/doi/10.1161/JAHA.120.019609acute kidney injuryend‐stage renal diseaseNOACsnon‐valvular atrial fibrillationrenal outcomeswarfarin |
| spellingShingle | Patita Sitticharoenchai Kullaya Takkavatakarn Smonporn Boonyaratavej Kearkiat Praditpornsilpa Somchai Eiam‐Ong Paweena Susantitaphong Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute kidney injury end‐stage renal disease NOACs non‐valvular atrial fibrillation renal outcomes warfarin |
| title | Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis |
| title_full | Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis |
| title_fullStr | Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis |
| title_full_unstemmed | Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis |
| title_short | Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis |
| title_sort | non vitamin k antagonist oral anticoagulants provide less adverse renal outcomes than warfarin in non valvular atrial fibrillation a systematic review and metaanalysis |
| topic | acute kidney injury end‐stage renal disease NOACs non‐valvular atrial fibrillation renal outcomes warfarin |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019609 |
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