Direct oral anticoagulants show lower risk for kidney disease progression vs. vitamin K antagonists

A Swedish cohort study shows 13% (95% CI, 2-22%) lower risk of kidney function decline or kidney failure and 12% (95% CI, 3-20%) lower risk of acute kidney injury with use of direct oral anticoagulants vs. vitamin K antagonists for non-valvular atrial fibrillation.

The relative safety of anticoagulation with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) remains inconclusive, particularly with regards to kidney outcomes.

In a cohort of patients with non-valvular atrial fibrillation from Sweden, researchers observed that compared with VKA, DOAC initiation was associated with a lower risk of the composite of kidney failure and sustained 30% eGFR decline, as well as a lower risk of AKI occurrence.

In agreement with trial evidence, DOAC vs VKA treatment was associated with a lower risk of major bleeding, but a similar risk of the composite of stroke, systemic embolism, or death.

Collectively, these findings recently published in the American Journal of Kidney Diseases (AJKD) add to emerging evidence on the safety and effectiveness of DOAC administered for atrial fibrillation.