ISSN 2996-8215
International Journal of Cardiology | Vol. 2, No. 5, May 2011 | pp. 33–40
DOI: 10.46882/2011/IJC/000026
Original Research Article
Safety and Efficacy of Direct Oral Anticoagulants versus Warfarin in Patients with Atrial Fibrillation and Severe Chronic Kidney Disease
Pierre Larson¹, Jean-Luc Moreau¹, Chantal Dubois²
¹Department of Cardiology, Hôpital de la Timone, Marseille, France
²Division of Nephrology, Clinique Universitaire de Bruxelles, Brussels, Belgium
Abstract:
Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, multiplicatively increasing thromboembolic and major bleeding risks. Traditional vitamin K antagonists like warfarin require tedious monitoring and carry high bleeding risks in renal failure. This observational study evaluated the safety and efficacy of a direct oral anticoagulant (DOAC), apixaban, compared to warfarin in patients with AF and stage 4 CKD. We analyzed data from 195 patients with non-valvular AF and an estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². Patients were prescribed either adjusted-dose apixaban (2.5 mg twice daily, n = 92) or warfarin (target INR 2.0–3.0, n = 103). The primary safety endpoint was major bleeding according to ISTH criteria, and the primary efficacy endpoint was a composite of stroke or systemic embolism over a 24-month follow-up. Major bleeding occurred significantly less frequently in the apixaban group than in the warfarin group (4.3% vs. 11.7%, hazard ratio: 0.36, 95% CI: 0.15–0.88, p = 0.02). The incidence of stroke or systemic embolism did not differ significantly between groups (apixaban: 2.2% vs. warfarin: 2.9%, hazard ratio: 0.74, 95% CI: 0.22–2.53, p = 0.63). Intracranial hemorrhage was completely absent in the apixaban cohort. In patients with atrial fibrillation and severe stage 4 chronic kidney disease, apixaban offers a significantly safer profile with lower major bleeding events compared to warfarin, while maintaining comparable efficacy in ischemic stroke prevention.
Keywords: Atrial fibrillation, Chronic kidney disease, Anticoagulants, Apixaban, Warfarin, Major bleeding
Received: February 20, 2011; Revised: March 24, 2011; Accepted: April 12, 2011; Published: May 20, 2011
Citation: International Journal of Cardiology, 2011, Vol. 2, No. 5, pp. 33–40, DOI: 10.46882/2011/IJC/000026