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Effectiveness and safety of oral anticoagulants for non-valvular atrial fibrillation: a population-based cohort study in primary healthcare in Catalonia
Conclusion: Being men, a previous event and DOAC-switch posed a higher risk for all study outcomes. direct oral anticoagulants had a protective effect against cerebral bleeding in comparison to vitamin K antagonists. Adherence to direct oral anticoagulants resulted in lower risk of stroke and cerebral bleeding. We found no differences in the risk of stroke and gastrointestinal bleeding when we compared direct oral anticoagulants vs. vitamin K antagonists.
Source: Frontiers in Pharmacology - September 15, 2023 Category: Drugs & Pharmacology Source Type: research

Cardiovascular and renal outcomes in patients with atrial fibrillation and stage 4 –5 chronic kidney disease receiving direct oral anticoagulants: a multicenter retrospective cohort study
AbstractThe role of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and stage 4 –5 chronic kidney disease (CKD) is controversial. Electronic medical records from 2012 to 2021 were retrieved for patients with AF and stage 4–5 CKD receiving oral anticoagulants. Patients were separated into those receiving DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) or vitamin K ant agonists (VKA). Primary outcomes included ischemic stroke (IS), systemic thrombosis (SE), major bleeding, gastrointestinal bleeding, hemorrhagic stroke, acute myocardial infarction, cardiovascular death, and all-cause dea...
Source: Journal of Thrombosis and Thrombolysis - August 21, 2023 Category: Hematology Source Type: research

Oral Anticoagulant Use in Patients With Atrial Fibrillation and Chronic Kidney Disease: A Review of the Evidence With Recommendations for Australian Clinical Practice
Chronic kidney disease is common in patients with atrial fibrillation (AF) and is associated with heightened risks of stroke/systemic embolisation and bleeding. In this review we outline the evidence for AF stroke prevention in kidney disease, identify current knowledge gaps, and give recommendations for anticoagulation at various stages of chronic kidney disease.Overall, anticoagulation is underused. Warfarin use becomes increasingly difficult with advancing kidney disease, with difficulty maintaining international normalised ratio (INR) in therapeutic range, increased risk of intracranial and fatal bleeding compared to n...
Source: Heart, Lung and Circulation - November 3, 2022 Category: Cardiology Authors: Christopher Hammett, Sunil V. Badve, Peter G. Kerr, Huyen A. Tran, Benjamin K. Dundon, Sidney Lo, Andrew Wong, Joanne E. Joseph, Jenny Deague, Vlado Perkovic Tags: Review Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: comment —Authors’ reply
We thank the authors for addressing this important issue.1 Indeed, the assessment of NOAC plasma levels —or potential alternatives—in special situations may represent an important element in the further refinement of non-vitamin K antagonist oral anticoagulant (NOAC) therapy. In their letter, Mbroh and Poli make a case for using point-of-care coagulation tests (POCT) to more rapidly assess the lev el of anticoagulant in patients’ blood samples. In the 2021 EHRA Practical Guide on the use of NOACs, we suggest to consider NOAC plamsa level assessment in two different types of scenarios: emergency situations (e.g. acute...
Source: Europace - September 4, 2021 Category: Cardiology Source Type: research

Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation: A post hoc Analysis from the AMADEUS Trial
Conclusion: Deteriorated renal function has a small negative impact on the quality of anticoagulation control with VKA which is linked to poor outcomes in AF. However, moderate renal failure itself was an independent risk factor for increased risk of stroke, major bleeding, and all-cause mortality amongst patients with AF.Cerebrovasc Dis
Source: Cerebrovascular Diseases - July 28, 2021 Category: Neurology Source Type: research

Oral anticoagulation in chronic kidney disease with atrial fibrillation
Nefrologia. 2021 Mar-Apr;41(2):137-153. doi: 10.1016/j.nefroe.2021.04.005. Epub 2021 May 10.ABSTRACTChronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist, amplifying the risk of cardiovascular events and mortality. In patients with CKD stage 3 and non-valvular AF, direct oral anticoagulants (DOACs) have shown, compared to vitamin K antagonists (VKA), equal or greater efficacy in the prevention of stroke and systemic embolism, and greater safety. There are no randomizedtrials of the efficacy and safety of DOACs and VKA in advanced CKD. On the other hand, observational studies suggest that DOACs, compa...
Source: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia - June 25, 2021 Category: Urology & Nephrology Authors: Pablo Gomez-Fern ández Antonio Mart ín Santana Juan de Dios Arjona Barrionuevo Source Type: research

Real-world comparison of direct-acting oral anticoagulants and vitamin K antagonists in chronic kidney disease: a systematic review and meta-analysis
Conclusion: DOACs are associated with only a modest reduction in stroke or systemic embolism, major bleeding, and mortality when compared to VKA in CKD patients. Reduction in mortality and major bleeding with DOAC may only be seen in moderate-to-severe CKD patients.PMID:33949923 | DOI:10.1080/17474086.2021.1920012
Source: Expert Review of Hematology - May 5, 2021 Category: Hematology Authors: Rongfang Xu Fan Wu Jiarong Lan Peixin Duan Source Type: research

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