Renal function and non-vitamin K oral anticoagulants in comparison with warfarin on safety and efficacy outcomes in atrial fibrillation patients: a systemic review and meta-regression analysis

Abstract Background A decline of estimated glomerular filtration rate (eGFR) has been described in atrial fibrillation (AF) patients on Vitamin K antagonists (VKAs). Few real-world data on the modifications of eGFR in AF patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) do exist. Purpose To evaluate changes of renal function in AF patients treated with VKAs or NOACs. Methods Multicentre prospective cohort study including 1,667 patients with non-valvular AF from 5 clinical centres of Internal Medicine and Cardiology in Italy. Renal endpoints were: 1) median annual decline of eGFR; 2) transition to eGFR <50 ml/min/1.73 m2; 3) eGFR class worsening according to KDIGO 2012 classification. The eGFR was assessed by the CKD-EPI formula at baseline and during follow-up. Results Median age was 73.7±9.1 years and 43.3% were women. 743 patients were on VKAs and 924 on NOACs (Dabigatran, Rivaroxaban e Apixaban). Median annual eGFR decline was −2,11 (Interquartile Range [IQR] −5,68/−0,62] in patients on VKAs, −0,27 [IQR −9,00/4,54] with Dabigatran (p<0.001 vs. VKAs), −1,21 [IQR −9,98/4,02] with Rivaroxaban (p=0.004 vs. VKAs) and −1,32 [IQR −8,7/3,99] with Apixaban (p=0.003, vs. VKAs). Use of Dabigatran and Apixaban was associated to a lower transition to eGFR <50 mL/min/1.73 m2, compared to VKAs: adjusted Odds Ratio (aOR) 0.492, 95% Confidence Interval (CI) 0.298–0.813, p=0.006 for Dabigatran; aOR 0.449, 95% CI 0.276–0.728, p=0.001 for Apixaban). Regarding the eGFR class worsening, Dabigatran (aOR 0.70, 95% CI 0.503–0.975, p=0.035), Rivaroxaban (aOR 0.591, 95% CI 0.423–0.825, p=0.002), and Apixaban (aOR 0.591, 95% CI 0.429–0.815, p=0.001) were all associated to a lower rate of eGFR class worsening compared to VKAs. Forest plot Conclusions In this prospective multicentre cohort study, NOACs use was associated with a lower decline of renal function compared to VKAs. Patients on Dabigatran showed the lowest annual rate of eGFR decline and those on Apixaban and Rivaroxaban a lower eGFR class worsening. Acknowledgement/Funding None

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Safety and efficacy of direct oral anticoagulants compared to Vitamin K antagonists postpercutaneous coronary interventions in patients with atrial fibrillation: A systematic review and meta‐analysis

Journal of Arrhythmia ◽

10.1002/joa3.12292 ◽

2020 ◽

Vol 36 (2) ◽

pp. 271-279

Author(s):

Pradyumna Agasthi ◽

Justin Z. Lee ◽

Sai Harika Pujari ◽

Andrew S. Tseng ◽

Justin Shipman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Vitamin K ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Safety And Efficacy ◽

Coronary Interventions

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SAFETY AND EFFICACY OF NON-VITAMIN K ORAL ANTICOAGULANTS (NOAC) VERSUS WARFARIN ACROSS VARIOUS TIME IN THERAPEUTIC RANGE (TTR) STRATA AMONG PATIENTS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2018.07.272 ◽

2018 ◽

Vol 34 (10) ◽

pp. S89-S90

Author(s):

J. Lee ◽

A. Ha ◽

P. Dorian ◽

S. Goodman ◽

J. Friedrich

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Vitamin K ◽

Therapeutic Range ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Safety And Efficacy ◽

Time In Therapeutic Range

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Which Patients Would Be Willing to Change Anticoagulation From Vitamin-K Antagonists to a New Oral Anticoagulant?

Blood ◽

10.1182/blood.v118.21.4318.4318 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4318-4318

Author(s):

Job Harenberg ◽

Svetlana Marx ◽

Nadja Abou-Ayash ◽

Christophe Kremer ◽

Vera Hoeing ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Vitamin K ◽

Logistic Regression Analysis ◽

Oral Anticoagulant ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

New Oral Anticoagulant ◽

Willingness To Change

Abstract Abstract 4318 New oral anticoagulants have generated promising data on the prophylaxis of systemic and non-systemic embolism in patients with atrial fibrillation and treatment of acute venous thromboembolism and prolonged prophylaxis of recurrent events. For patients on chronic treatment with vitamin-K antagonists (VKA) we analysed the motivation and willingness to change the anticoagulation from VKA to new oral anticoagulants. Patients (n=110) on stable treatment with VKA for at least 3 months (indication for anticoagulation: atrial fibrillation or VTE) completed a validated personality inventory (Freiburger Persönlichkeitsinventar FPI-R), and a self-developed questionnaire on general attitudes regarding anticoagulant therapy (Q1). Patients were divided in two groups according to the reply to the question weather they were willing to switch to a new oral anticoagulant. Out of these sets of questions 7 questions were identified by means of a logistic regression analysis for the willingness to change anticoagulation with VKA to a new oral anticoagulant. The same patients completed this shortened questionnaire (Q2) (n=85) thereafter. Logistic regression analysis defined the 7 items of the FPI and Q1 questionaires as relevant for willingness of patients to change the medication. The probability to change medication was 98% using the 7 questions (Q2) compared to the 2 comlete questionnaires. The items were: extraversion – introversion scale on the FPI-R consisting of 14 questions, and from Q1: hope for a better quality of life with a new anticoagulant, no scepticism for new drugs, wish of a lack of routine monitoring for dose adjustment, relevance of the practitioners opinion, thoughts in the past of alternatives for anticoagulation, and difficulty to adjust the prothrombin time. Using Q2 85% of patients confirmed to be willing to change the anticoagulant drug compared to Q1 (chi square test p<0.0001). Seven questions were identified and confirmed to identify patients for their willingness to change anticoagulation from VKA to a new oral anticoagulant. Disclosures: No relevant conflicts of interest to declare.

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Impact of renal function deterioration on adverse events during anticoagulation therapy using non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

Heart and Vessels ◽

10.1007/s00380-015-0725-6 ◽

2015 ◽

Vol 31 (8) ◽

pp. 1327-1336 ◽

Cited By ~ 10

Author(s):

Koji Miyamoto ◽

Takeshi Aiba ◽

Shoji Arihiro ◽

Makoto Watanabe ◽

Yoshihiro Kokubo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Renal Function ◽

Adverse Events ◽

Vitamin K ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Vitamin K Antagonist ◽

Renal Function Deterioration

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444 Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: a systematic review and meta-regression

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127.002 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Marco Borgi ◽

Marco Proietti ◽

Giulio Francesco Romiti ◽

Marco Vitolo ◽

Arianna Di Rocco ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Regression Analysis ◽

Electronic Devices ◽

Older Age ◽

Cardiac Implantable Electronic Devices ◽

History Of ◽

Meta Regression ◽

Meta Regression Analysis

Abstract Aims In recent years, attention to subclinical atrial fibrillation (SCAF), defined as the presence of atrial high-rate episodes (AHREs), in patients with cardiac implantable electronic devices (CIEDs), has gained much interest as a determinant of clinical AF and stroke risk. To perform a systematic review and meta-regression of the available scientific evidence regarding the epidemiology of SCAF in patients receiving CIEDs. Methods and results PubMed and EMBASE were searched for all studies documenting the incidence of AHREs in patients (n = 100 or more) with CIEDs without any previous history of AF from inception to 20 August 2021, screened by two independent blind reviewers. This study was registered in PROSPERO: CRD42019106994. Among the 2614 results initially retrieved, 54 studies were included, with a total of 72 784 patients. Meta-analysis of included studies showed a pooled prevalence of SCAF of 28.1%, with an incidence rate (IR) of 16 new SCAF cases per 100 patient-years (I2 = 100%). Multivariate meta-regression analysis showed that age and follow-up time were the only significant determinants of IR, explaining a large part of the heterogeneity (R2 = 61.5%, P < 0.001), with higher IR at earlier follow-up and in older patients, decreasing over follow-up time and increasing according to mean age. Older age, higher CHA2DS2-VASc score, history of AF, hypertension, CHF, and stroke/TIA were all associated with SCAF occurrence. Conclusions In this systematic review and meta-regression analysis, IR of SCAF increased with age and decreased over longer follow-up times. SCAF was associated with older age, higher thromboembolic risk, and several cardiovascular comorbidities.

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