Meta-analysis of safety and efficacy for direct oral anticoagulation treatment of non-valvular atrial fibrillation in relation to renal function

Analysis of five RCTs comparing DOACs to warfarin in atrial fibrillation (n=72,608) found stroke risk was lower with DOACs than warfarin in both mild (RR 0.79; 95% CI 0.68–0.91) and moderate (0.80, 0.69–0.92) renal impairment, with no major differences in normal renal function.

The study also reports that DOACs were associated with fewer major bleeds among patients with normal (RR 0.77, 0.70–0.84), mild (0.86, 0.77–0.95), and moderate renal impairment (0.73, 0.65–0.82).

 

A further analysis used data from two studies to explore the change in renal function in the DOAC and warfarin groups, and this suggests that overall the decline in eGFR was greater for warfarin than for DOACs; however in one study the observed difference was not statistically significant after Bonferroni correction. This observation should be considered as hypothesis generating only and would need exploring in further studies.