Direct oral anti-Xa anticoagulants versus warfarin in newly diagnosed atrial fibrillation and CKD: the Korean National Health Insurance Data

被引:1
作者
Kee, Youn Kyung [1 ,2 ]
Jeon, Hee Jung [1 ]
Oh, Jieun [1 ]
Yoo, Tae-Hyun [2 ]
Kang, Dongwoo [3 ]
Lee, Jungkuk [3 ]
Shin, Dong Ho [1 ]
机构
[1] Hallym Univ, Kangdong Sacred Heart Hosp, Coll Med, Dept Internal Med, Seoul, South Korea
[2] Yonsei Univ, Coll Med, Dept Internal Med, Seoul, South Korea
[3] Hanmi Pharm Co Ltd, Data Sci Team, Seoul, South Korea
关键词
atrial fibrillation; chronic kidney disease; direct oral anti-Xa anticoagulants; effectiveness; safety; warfarin; CHRONIC KIDNEY-DISEASE; HEMODIALYSIS-PATIENTS; DIALYSIS PATIENTS; SAFETY; EFFICACY; STROKE; METAANALYSIS; RIVAROXABAN; PREVENTION; GUIDELINES;
D O I
10.3389/fmed.2023.1212816
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Despite the benefits of direct oral anti-Xa anticoagulants (DOACs), the risk-benefit profile of DOAC therapy compared to warfarin therapy in patients with non-valvular atrial fibrillation (AF) and chronic kidney disease (CKD), including end-stage renal disease (ESRD), is uncertain.Methods: We conducted a retrospective study using the Korea National Health Insurance Database from 2013 to 2018. We evaluated patients with incident non-valvular AF and CKD. The primary and secondary effectiveness outcomes were ischemic stroke and all-cause mortality. The primary safety outcomes included intracranial hemorrhage, gastrointestinal bleeding, and extracranial or unclassified major bleeding.Results: Among the 1,885 patients evaluated, 970 (51.5%) initiated warfarin therapy, and 915 (48.5%) initiated DOAC therapy. During a mean follow-up period of 23.8 months, there were 293 and 214 cases of ischemic stroke and all-cause death, respectively. Kaplan-Meier survival analysis showed significantly lower all-cause mortality in DOAC users than in warfarin users. In multivariate Cox regression analyses, DOAC therapy had a hazard ratio for all-cause mortality of 0.41 (95% CI, 0.30-0.56; p < 0.001) compared to warfarin therapy. Additionally, DOAC therapy significantly reduced intracranial hemorrhage and gastrointestinal bleeding.Discussion: Our study demonstrates that DOAC therapy has a better risk-benefit profile than warfarin therapy in patients with AF and CKD. Further well-designed clinical trials are needed to clarify the benefits of DOACs in this patient population.
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页数:10
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共 47 条
  • [1] Pharmacology and management of the vitamin K antagonists
    Ansell, Jack
    Hirsh, Jack
    Hylek, Elaine
    Jacobson, Alan
    Crowther, Mark
    Palareti, Gualtiero
    [J]. CHEST, 2008, 133 (06) : 160S - 198S
  • [2] Anticoagulation in chronic kidney disease: from guidelines to clinical practice
    Aursulesei, Viviana
    Costache, Irina Iuliana
    [J]. CLINICAL CARDIOLOGY, 2019, 42 (08) : 774 - 782
  • [3] Camm AJ, 2010, EUR HEART J, V31, P2369, DOI [10.1093/eurheartj/ehq278, 10.1093/europace/euq350]
  • [4] Effect of Rivaroxaban or Apixaban in Atrial Fibrillation Patients with Stage 4-5 Chronic Kidney Disease or on Dialysis
    Chen, Chen
    Cao, Yalin
    Zheng, Ying
    Dong, Yugang
    Ma, Jianyong
    Zhu, Wengen
    Liu, Chen
    [J]. CARDIOVASCULAR DRUGS AND THERAPY, 2021, 35 (02) : 273 - 281
  • [5] Efficacy and Safety of Direct Oral Anticoagulants vs Warfarin in Patients with Chronic Kidney Disease and Dialysis Patients: A Systematic Review and Meta-Analysis
    Chen, Hsin-Yu
    Ou, Shih-Hsiang
    Huang, Chien-Wei
    Lee, Po-Tsang
    Chou, Kang-Ju
    Lin, Pei-Chin
    Su, Yi-Chia
    [J]. CLINICAL DRUG INVESTIGATION, 2021, 41 (04) : 341 - 351
  • [6] Outcomes After Use of Standard- and Low-Dose Non-Vitamin K Oral Anticoagulants in Asian Patients With Atrial Fibrillation
    Cho, Min Soo
    Yun, Ji Eun
    Park, Ji Jeong
    Kim, Yun Jung
    Lee, Jessie
    Kim, Hyungmin
    Park, Duk-Woo
    Nam, Gi-Byoung
    [J]. STROKE, 2019, 50 (01) : 110 - 118
  • [7] Dabigatran versus Warfarin in Patients with Atrial Fibrillation.
    Connolly, Stuart J.
    Ezekowitz, Michael D.
    Yusuf, Salim
    Eikelboom, John
    Oldgren, Jonas
    Parekh, Amit
    Pogue, Janice
    Reilly, Paul A.
    Themeles, Ellison
    Varrone, Jeanne
    Wang, Susan
    Alings, Marco
    Xavier, Denis
    Zhu, Jun
    Diaz, Rafael
    Lewis, Basil S.
    Darius, Harald
    Diener, Hans-Christoph
    Joyner, Campbell D.
    Wallentin, Lars
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) : 1139 - 1151
  • [8] Prevalence of chronic kidney disease in the United States
    Coresh, Josef
    Selvin, Elizabeth
    Stevens, Lesley A.
    Manzi, Jane
    Kusek, John W.
    Eggers, Paul
    Van Lente, Frederick
    Levey, Andrew S.
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 298 (17): : 2038 - 2047
  • [9] Safety and Efficacy of Vitamin K Antagonists versus Rivaroxaban in Hemodialysis Patients with Atrial Fibrillation: A Multicenter Randomized Controlled Trial
    De Vriese, An S.
    Caluwe, Rogier
    Van Der Meersch, Hans
    De Boeck, Koen
    De Bacquer, Dirk
    [J]. JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2021, 32 (06): : 1474 - 1483
  • [10] Warfarin, Calciphylaxis, Atrial Fibrillation, and Patients on Dialysis: Outlier Subsets and Practice Guidelines
    Eiser, Arnold R.
    [J]. AMERICAN JOURNAL OF MEDICINE, 2014, 127 (04) : 253 - 254