Investigators found an incremental increase in risks from oral anticoagulants as kidney function decreased, highlighting the need for more research to better understand bleeding risk and net benefit of treatment in the CKD population.
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Although more research is needed, data suggest that the cardioprotective effect of direct oral anticoagulants may extend to patients with advanced CKD.
Risks for ischemic stroke or systemic embolism, major bleeding events lower with DOACs overall as a class versus warfarin
No differences seen in fracture risk in head-to-head comparisons of direct oral anticoagulants
Efficacy similar to aspirin for preventing recurrent stroke after embolic stroke of undetermined source
For patients initiating oral anticoagulant therapy, the incidence of hospitalization for upper gastrointestinal bleeding is highest and lowest with rivaroxaban and apixaban, respectively.
Compared with warfarin, apixaban was correlated with reduced risk of major bleeding and intracranial bleeding (adjusted hazard ratios, 0.66 and 0.4, respectively) and dabigatran was correlated with reduced risk of intracranial bleeding (adjusted hazard ratio, 0.45) among patients with atrial fibrillation.
The researchers found that the risk of developing an intraocular hemorrhage was reduced with dabigatran or rivaroxaban at 365 days (hazard ratio, 0.75; 95% confidence interval, 0.58 to 0.97; P=0.03) but not at 90 days (hazard ratio, 0.73; 95% confidence interval, 0.22 to 2.63; P=0.13).
Compared with warfarin, dabigatran and rivaroxaban linked to lower risk of adverse renal outcomes
Researchers performed a retrospective cohort study to compare incidence of stroke, bleeding, and myocardial infarction in patients with atrial fibrillation initiating dabigatran or warfarin (n=25,289 for each) from November 2010 to May 2014.