18 Apr 2023 • Standard-dose direct oral anticoagulants (DOACs) safely bested both lower doses and warfarin among patients with kidney dysfunction in subgroup analysis across pivotal clinical trials in atrial fibrillation (AF). Too often, patients with kidney dysfunction who do not meet criteria for DOAC dose reduction are under-dosed in an attempt to reduce the risk of bleeding or other complications from anticoagulation, despite being a group at higher risk of complications from atrial fibrillation, researchers noted.

The network meta-analysis included 71,683 patients (mean age 70.6 years, 37% female) with a median follow-up of 23.1 months.

The findings as published in the journal Circulation are as follows:

• Standard-dose DOACs are safer and more effective than warfarin down to a Creatinine clearance of at least 25 mL/min.
• Lower-dose DOACs do not significantly lower the incidence of bleeding or intracranial hemorrhage compared with standard-dose DOACs but are associated with a higher incidence of stroke and systemic embolism and death.
• These findings support the use of standard-dose DOACs over warfarin in patients with kidney dysfunction.

Source: AHA Journals| Read full story