Recent evidence for direct oral anticoagulants in chronic kidney disease

Current Opinion in Nephrology and Hypertension
Jeffrey T HaMin Jun

Abstract

The direct oral anticoagulants (DOACs) have emerged as an effective and safe alternative to vitamin K antagonists (VKAs) for stroke and venous thromboembolism (VTE) prevention. However, patients with chronic kidney disease (CKD) experience an increase in the risk of both thromboembolism and bleeding, and the risk-benefit profile of DOACs, particularly in advanced CKD remains a source of ongoing debate. This review summarizes the recent evidence on the effects of DOACs in CKD across a range of clinical indications including newly emerging indications. Data on early-to-moderate stage CKD derived from pivotal randomized controlled trials in broader atrial fibrillation and VTE populations support the favorable risk-benefit ratio of DOACs compared with VKAs in patients in these groups. However, safety data from observational studies comparing DOACs with VKAs in patients with atrial fibrillation and CKD (moderate to advanced) have been conflicting. Recent trials have evaluated the efficacy of low-dose DOACs on major cardiovascular outcomes, showing promising risk-benefit ratios in high-risk populations with concurrent CKD. Current data on patients with CKD derived from trials in the broader population suggest that DOACs are an effect...Continue Reading

References

Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Apr 15, 2010·Seminars in Thrombosis and Hemostasis·Diana I JalalGiovanni Targher
Dec 7, 2010·The New England Journal of Medicine·Rupert BauersachsSebastian Schellong
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Aug 30, 2011·Blood Reviews·Sue Pavord, Bethan Myers
Nov 16, 2011·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Jiing-Chyuan LuoShou-Dong Lee
Mar 28, 2012·The New England Journal of Medicine·Harry R BüllerAnnelise Segers
Feb 16, 2013·The American Journal of Medicine·Jiing-Chyuan LuoJaw-Wen Chen
May 4, 2013·Mayo Clinic Proceedings·Wilson I GonsalvesMrinal M Patnaik
Jun 12, 2013·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Khai P NgCharles J Ferro
Nov 21, 2013·The New England Journal of Medicine·Robert P GiuglianoUNKNOWN ENGAGE AF-TIMI 48 Investigators
Jan 18, 2015·Circulation·Kevin E ChanFranklin W Maddux
Jan 31, 2015·Current Opinion in Nephrology and Hypertension·Ziv HarelJeffrey Perl
Jan 30, 2016·Journal of the American Society of Nephrology : JASN·Amber O MolnarManish M Sood
Feb 5, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Ki Hong LeeJong Chun Park
Jul 1, 2016·Circulation·Erin A BohulaEugene Braunwald
Oct 5, 2016·The American Journal of Emergency Medicine·John Eikelboom, Geno Merli
Jun 10, 2017·Journal of the American College of Cardiology·Xiaoxi YaoPeter A Noseworthy
Aug 29, 2017·The New England Journal of Medicine·John W EikelboomUNKNOWN COMPASS Investigators
May 17, 2018·The New England Journal of Medicine·Robert G HartUNKNOWN NAVIGATE ESUS Investigators
Jun 30, 2018·Journal of the American College of Cardiology·Christina Ji-Young LeeChristian Torp-Pedersen
Jul 14, 2018·Clinical Journal of the American Society of Nephrology : CJASN·Jung-Im ShinMorgan E Grams
Aug 28, 2018·The New England Journal of Medicine·Alex C SpyropoulosUNKNOWN MARINER Investigators
Aug 28, 2018·The New England Journal of Medicine·Faiez ZannadUNKNOWN COMMANDER HF Investigators

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Citations

Mar 8, 2020·Pharmacy : Journal of Pharmacy, Education and Practice·Soo Min JangHuyentran Tran

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