scholarly journals Net clinical benefit of non-vitamin K antagonist oral anticoagulants in atrial fibrillation and chronic kidney disease: a trade-off analysis from four phase III clinical trials

2019 ◽  
Vol 9 (5) ◽  
pp. 410-419 ◽  
Author(s):  
Zhi-Chun Gu ◽  
Ling-Cong Kong ◽  
Shuo-Fei Yang ◽  
An-Hua Wei ◽  
Na Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Clinical Trials ◽  
Kidney Disease ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Phase Iii ◽  
Trade Off ◽  
Phase Iii Clinical Trials ◽  
Net Clinical Benefit

scholarly journals Non-vitamin K antagonist oral anticoagulants vs. vitamin-K antagonists in patients with atrial fibrillation and chronic kidney disease: a nationwide cohort study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Emma Kirstine Laugesen ◽  
Laila Staerk ◽  
Nicholas Carlson ◽  
Anne-Lise Kamper ◽  
Jonas Bjerring Olesen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vitamin K ◽  
Major Bleeding ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
All Cause Mortality ◽  
Comparable Population

Abstract Background We aimed to compare effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin-K antagonists (VKA) in atrial fibrillation (AF) patients with chronic kidney disease (CKD) not receiving dialysis. Methods By using personal identification numbers, we cross-linked individual-level data from Danish administrative registries. We identified every citizen with a prior diagnosis of AF and CKD who initiated NOAC or VKA (2011–2017). An external analysis of 727 AF patients with CKD (no dialysis) was performed to demonstrate level of kidney function in a comparable population. Study outcomes included incidents of stroke/thromboembolisms (TEs), major bleedings, myocardial infarctions (MIs), and all-cause mortality. We used Cox proportional hazards models to determine associations between oral anticoagulant treatment and outcomes. Results Of 1560 patients included, 1008 (64.6%) initiated VKA and 552 (35.4%) initiated NOAC. In a comparable population we found that 95.3% of the patients had an estimated glomerular filtration rate (eGFR) < 59 mL/min. Patients treated with NOAC had a significantly decreased risk of major bleeding (hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.26–0.84) compared to VKA. There was not found a significant association between type of anticoagulant and risk of stroke/TE (HR: 0.83, 95% CI: 0.39–1.78), MI (HR: 0.45, 95% CI: 0.18–1.11), or all-cause mortality (HR: 0.99, 95% CI: 0.77–1.26). Conclusion NOAC was associated with a lower risk of major bleeding in patients with AF and CKD compared to VKA. No difference was found in risk of stroke/TE, MI, and all-cause mortality.

scholarly journals Individualising Anticoagulant Therapy in Atrial Fibrillation Patients

2016 ◽  
Vol 5 (2) ◽  
pp. 102 ◽  
Author(s):  
Marco Alings ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
The Other ◽  
Phase Iii ◽  
European Medicines Agency ◽  
Efficacy And Safety ◽  
Pivotal Phase ◽  
Phase Iii Clinical Trials ◽  
Dosing Regimens

Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have emerged as alternatives to VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation. Four NOACs: dabigatran, apixaban, rivaroxaban and edoxaban, have received regulatory approval in Europe from the European Medicines Agency. Numerous factors can influence the decision to prescribe a NOAC, the most important of which are assessment of stroke and bleeding risks. Given the variation in design of the pivotal phase III clinical trials investigating the efficacy and safety of NOACs, and in the absence of head-to-head comparative data, it is impossible to recommend one NOAC over the other. However, NOACs offer the opportunity for individualised therapy based on factors such as renal function, age or patient/doctor preference for once- or twice-daily dosing regimens. Dose reduction of some NOACs should be considered in at-risk patient populations.

Atrial fibrillation and chronic kidney disease

ESC CardioMed ◽  
2018 ◽  
pp. 2237-2240
Author(s):  
Ken Okumura ◽  
Hirofumi Tomita
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Cardiovascular Complications ◽  
Vitamin K Antagonist ◽  
Bleeding Complications ◽  
The Common

Atrial fibrillation (AF) is one of the common cardiovascular complications in patients with chronic kidney disease (CKD), and enhances synergistically the risks of stroke, systemic thromboembolism, and bleeding complications, resulting in increased mortality. One major concern in the treatment strategy for patients with AF and CKD has been a lack of robust evidence that improves quality of life and prognosis. Although a paradigm shift from warfarin to non-vitamin K antagonist oral anticoagulants has occurred in stroke prevention in AF, the role and indication of non-vitamin K antagonist oral anticoagulants remain to be established in patients with advanced CKD. Considering the fact that the prevalence of CKD in the general population increases with age, elderly people suffering from both CKD and AF will be increasingly frequent in the highly aged societies.

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