NOACs tied to lower renal function decline in patients with atrial fibrillation

A prescription of nonvitamin K antagonist (VKA) oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) leads to a lower renal function worsening compared to those receiving VKAs, suggests a recent study, adding that such effect is partially lost in diabetic patients.

The investigators conducted this multicentre prospective cohort study to examine the decrease in estimated glomerular filtration rate (eGFR) among AF patients treated with VKAs or NOACs. A total of 1,667 patients with nonvalvular AF (median age, 73.7 years; 43.3 percent women) were enrolled. The eGFR was assessed using the CKD-EPI formula at baseline and during follow-up.

The median annual decline of eGFR according to VKA (n=743) or NOAC (n=924) use was the primary endpoint. Secondary endpoints included the transition to eGFR <50 mL/min/1.73 m² and the eGFR class worsening.

Patients taking VKA showed an eGFR decline of –2.11 (interquartile range [IQR], –5.68 to –0.62), which was –0.27 (IQR, –9.00 to 4.54; p<0.001 vs VKAs) in patients on dabigatran, –1.21 (IQR, –9.98 to 4.02; p=0.004) on rivaroxaban, and –1.32 (IQR, –8.70 to 3.99; p=0.003) on apixaban.

Patients treated with dabigatran (odds ratio [OR], 0.492, 95 percent confidence interval [CI], 0.298–0.813; p=0.006) and apixaban (OR, 0.449, 95 percent CI, 0.276–0.728; p=0.001) showed lower transition to eGFR <50 mL/min/1.73 m².

Compared with VKA, all groups of NOACs showed a lower rate of eGFR class worsening. No difference was seen between full and reduced dose of NOAC.

In subgroup analysis, a significant reduction was observed in the association between NOAC and eGFR changes among patients with diabetes.