Effectiveness and safety of rivaroxaban versus warfarin in Taiwanese patients with end-stage renal disease and nonvalvular atrial fibrillation: A real-world nationwide cohort study

Lin, Yi; Chen, Bi Li; Shih, Chün Ming; Lin, Feng Yen; Chen, Chih‐Wei; Hsu, Chien Yi; Kao, Yung Ta; Bi, Wei; Chen, Li Ying; Chien, Li‐Nien; Fang, Te Chao; Huang, Chun Yao

doi:10.1371/journal.pone.0249940

Cited by 22 publications

(27 citation statements)

References 40 publications

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“…38,39 Of the 8 remaining retrospective studies, 4 reported efficacy data between DOAC therapy and warfarin, and only 1 found a difference in favor of DOAC therapy. 37,40,41,43 Additionally, Miao et al 46 reported no difference between apixaban and rivaroxaban. Despite a lack of efficacy data, safety outcomes favor DOAC use in patients with AF and CKD-5 or ESKD.…”

Section: Discussionmentioning

confidence: 99%

“…The prospective study by De Vriese et al 38 utilized rivaroxaban 10 mg daily, whereas 1 observational study included 155 (90%) patients on 10 or 15 mg daily and another included 560 (70%) patients on the standard dose of 20 mg daily. 37,38,46…”

Section: Discussionmentioning

confidence: 99%

“…The extension study reported improvement in a composite efficacy end point with rivaroxaban. 39 The observational study by Lin et al 37 found a benefit in favor of rivaroxaban in the combined end point of ischemic stroke and systemic embolism and no difference in bleeding. Miao et al 46 found no differences between apixaban and rivaroxaban with any end point.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

“…The use of rivaroxaban and warfarin in patients with AF and CKD-5, both with and without dialysis, was evaluated by Lin et al 37 in a retrospective population-based cohort study using Taiwan's National Health Insurance Research Database. The study evaluated 173 patients on rivaroxaban and 3185 on warfarin.…”

Section: Outcome Studiesmentioning

confidence: 99%

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A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease

et al. 2021

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Objective: To evaluate the role of oral anticoagulation in patients with stage 5 chronic kidney disease (CKD-5) or end-stage kidney disease (ESKD). Data Sources: A literature search of PubMed (January 2000 to July 1, 2021), the Cochrane Library, and Google Scholar databases (through April 1, 2021) was performed with keywords DOAC (direct-acting oral anticoagulant) OR NOAC or dabigatran OR rivaroxaban OR apixaban OR edoxaban AND end-stage kidney disease combined with atrial fibrillation (AF) or venous thromboembolism (VTE) OR pulmonary embolism OR deep-vein thrombosis. Study Selection and Data Extraction: Case-control, cohort, and randomized controlled trials comparing DOACs to an active control for AF or VTE in patients with CKD-5 or ESKD and reporting outcomes of stroke, recurrent thromboembolism, or major bleeding were included. Data Synthesis: Nine studies were included. Efficacy data supporting routine use of warfarin or DOACs in CKD-5 or ESKD are limited. Rivaroxaban and apixaban may provide enhanced safety compared to warfarin in patients with AF. Data for VTE are limited to 1 retrospective study. Relevance to Patient Care and Clinical Practice: Because of the paucity of rigorous, prospective studies in CKD-5 or ESKD, OACs should not be broadly used in this population. It is clear that data regarding efficacy of DOACs cannot be reliably and safely extrapolated from the non-ESKD population. Therefore, use of OACs in this population should be individualized. Conclusions: If OACs for stroke prevention with AF are deemed necessary, apixaban or rivaroxaban can be considered. DOACs cannot currently be recommended over warfarin in patients with CKD-5 or ESKD and VTE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

Section: Outcome Studiesmentioning

confidence: 99%

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A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease

et al. 2021

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“…Table 3 (Ref. [39][40][41][44][45][46][47]) and Table 4 (Ref. [39][40][41][44][45][46][47]) summarize all the large-scale trials mentioned below.…”

Section: Doacs As a Treatment Option For Patients With Af On Hemodial...mentioning

confidence: 99%

Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse

Ktenopoulos¹,

Sagris²,

Theofilis³

et al. 2022

Front. Biosci. (Schol Ed)

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The most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease (ESKD). On the other hand, direct OACs (DOACs) are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio (INR) monitoring. For those patients, warfarin and apixaban appear to be FDA-approved, whereas dabigatran, rivaroxaban, and edoxaban are not recommended yet. Due to a lack of large randomized studies, data from major trials cannot be extended to dialysis patients. In this review, we summarize the available data and literature referring to patients on chronic hemodialysis with concomitant AF. Due to the scarcity of data, we try to assist clinicians in selecting the appropriate therapy according to the specific characteristics of each patient. Finally, future directions are provided in two key areas of focus: left atrial appendage closure therapies and genetic research.

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A systematic review of the efficacy and safety of anticoagulants in advanced chronic kidney disease

et al. 2022

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Background Patients with chronic kidney disease (CKD) have an increased risk of venous thromboembolism (VTE) and atrial fibrillation (AF). Anticoagulants have not been studied in randomised controlled trials with CrCl < 30 ml/min. The objective of this review was to identify the impact of different anticoagulant strategies in patients with advanced CKD including dialysis. Methods We conducted a systematic review of randomized controlled trials and cohort studies, searching electronic databases from 1946 to 2022. Studies that evaluated both thrombotic and bleeding outcomes with anticoagulant use in CrCl < 50 ml/min were included. Results Our initial search yielded 14,503 papers with 53 suitable for inclusion. RCTs comparing direct oral anticoagulants (DOACs) versus warfarin for patients with VTE and CrCl 30-50 ml/min found no difference in recurrent VTE events (RR 0.68(95% CI 0.42–1.11)) with reduced bleeding (RR 0.65 (95% CI 0.45–0.94)). Observational data in haemodialysis suggest lower risk of recurrent VTE and major bleeding with apixaban versus warfarin. Very few studies examining outcomes were available for therapeutic and prophylactic dose low molecular weight heparin for CrCl < 30 ml/min. Findings for patients with AF on dialysis were that warfarin or DOACs had a similar or higher risk of stroke compared to no anticoagulation. For patients with AF and CrCl < 30 ml/min not on dialysis, anticoagulation should be considered on an individual basis, with limited studies suggesting DOACs may have a preferable safety profile. Conclusion Further studies are still required, some ongoing, in patients with advanced CKD (CrCl < 30 ml/min) to identify the safest and most effective treatment options for VTE and AF.

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Effectiveness and safety of rivaroxaban versus warfarin in Taiwanese patients with end-stage renal disease and nonvalvular atrial fibrillation: A real-world nationwide cohort study

Cited by 22 publications

References 40 publications

A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease

A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease

Direct Oral Anticoagulants in Patients on Chronic Dialysis and Concomitant Atrial Fibrillation: A Common Clinical Impasse

A systematic review of the efficacy and safety of anticoagulants in advanced chronic kidney disease

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