MacPlus Federated Search is being upgraded to ACCESSSS Smart Search!

MacPlus Federated Search is in the process of being shut down. Its new and better successor, ACCESSSS Smart Search, will operate in its place.

An automated system can transfer your account to ACCESSSS Smart Search. To complete the transfer, which will migrate information such as your user profile, alert settings, saved articles, and recently alerted articles, simply enter your email and password below.


If you don't want to migrate your user account to ACCESSSS Smart Search that's cool too -- rest assured that when MacPlus Federated Search is completely shut down we will delete your user profile and all related data from our servers.

NB: This means you only have a limited amount of time to take us up on our offer of a one-click migration of all your MacPlus Federated Search user data to ACCESSSS Smart Search, so if you're on the fence, hurry up and decide!

Zhang C, Gu ZC, Ding Z, et al. Decreased risk of renal impairment in atrial fibrillation patients receiving non-vitamin K antagonist oral anticoagulants: A pooled analysis of randomized controlled trials and real-world studies. Thromb Res. 2019 Feb;174:16-23. doi: 10.1016/j.thromres.2018.12.010. Epub 2018 Dec 6.
Area Score
Cardiology
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Internal Medicine
Hemostasis and Thrombosis
Abstract

BACKGROUND: Patients with warfarin have a potential risk of warfarin-related nephropathy, which could result in the discontinuation of anticoagulation therapy. The question of whether non-vitamin K antagonist oral anticoagulants (NOACs) use is associated with increased risk of renal impairment in atrial fibrillation (AF) patients remains unanswered.

METHODS: Studies were systematically searched through Medline, Embase, Cochrane Library databases, and ClinicalTrials.gov Website. Randomized controlled trials (RCTs) reporting renal impairment events and observational nationwide database studies presenting adjusted hazard ratio (HR) in AF patients with NOACs were identified. The Primacy outcome was renal impairment, defined as a composite of any renal disorder. The secondary outcomes were narrow definition of renal failure (including renal failure, acute renal failure, chronic renal failure, acute prerenal failure and postrenal failure) and individual renal impairment reported in involved studies. HR and 95% confidence intervals (95%CI) were calculated using fixed- or random-effects models according to the extent of heterogeneity. Subgroup analyses were conducted according to individual NOACs, study types and different controls.

RESULTS: Totally, 189,483 patients from 11 RCTs and 3 observational database studies were included in the analysis (119,188 patients with NOACs and 70,295 patients with vitamin K Antagonists or acetylsalicylic acid). Overall results indicated a significantly lower risk of renal impairment in AF patients with NOACs versus VKAs/acetylsalicylic acid (HR: 0.67, 95%CI: 0.62-0.73). Results of narrow definition of renal impairment were accordant with the primacy outcome (HR: 0.65, 95%CI: 0.60-0.71). Compared with VKAs or acetylsalicylic acid, dabigatran (HR: 0.64, 95%CI: 0.56-0.72), rivaroxaban (HR: 0.66, 95%CI: 0.55-0.77) and apixaban (HR: 0.73, 95%CI: 0.59-0.87) were all associated with a significantly lower risk of renal impairment, with the exception of edoxaban (HR: 0.79, 95%CI: 0.30-1.27).

CONCLUSIONS: Patients with NOACs might bring about a lower risk of renal impairment compared to VKA or acetylsalicylic acid. Further specialized designs of RCTs and real-world studies on evaluation of renal function are warranted to obtain a robust result on this issue.

Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

If this paper is selected, I would ask the commentator to address issues that include the potential for selective reporting or non-reporting of the renal outcomes in these trials.

Internal Medicine rater

It's an interesting initial study. I agree with the authors that additional rigorous study to evaluate this seeming correlation is warranted. However, this study alone should not change or influence clinical practice at this time.