COMPARATIVE EFFICACY OF DIRECT ORAL ANTICOAGULANTS VS WARFARIN IN ATRIAL FIBRILLATION PATIENTS WITH CHRONIC KIDNEY DISEASE
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Keywords
Atrial Fibrillation, Chronic Kidney Disease, Direct Oral Anticoagulants, Warfarin, Stroke Prevention, Bleeding Risk, Anticoagulation Therapy.
Abstract
Background: Atrial fibrillation (AF) is a common arrhythmia, and its risk for stroke is increased in patients with chronic kidney disease (CKD). Given that this risk is crucially dependent on anticoagulation therapy, historically warfarin has been used in its treatment. Direct oral anticoagulants (DOACs) are also becoming alternate treatments, with potentially superior efficacy and safety characteristics compared with patients with CKD.
Objectives: The objective of this review was to compare DOAC vs warfarin efficacy and safety for AF management in patients with CKD on outcomes of stroke prevention, bleeding, and mortality.
Methodology: The comparative effectiveness of DOACs and warfarin was analyzed in CKD patients, with AF, through a systematic review of recent studies, meta-analyses and clinical trials. Peer-reviewed articles from 2019 through 2023 were reviewed, including many endpoints and patient populations.
Results: A review is performed that demonstrates that DOACs (apixaban and edoxaban in particular) are superior to warfarin in preventing stroke and have a more favorable safety profile with respect to major bleeding events. DOACs continue to give these benefits, as shown across all stages of CKD and even in moderate to severe CKD following dose adjustments.
Conclusion: Nevertheless, DOACs show promise as alternatives to warfarin for AF patients with CKD, whose burden of bleeding is reduced relative to warfarin. In clinical practice, they should be used as a priority as they may prevent warfarin associated adverse events particularly in the intermediate stages of CKD.
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Aisha Alyassi
Medical Intern, Sheikh Shakhbout Medical City, Abudhabi, UAE
Muhammad Sarosh Iqbal
Rawalpindi Medical University & Allied Hospitals
Roukaya Lamine Hamadi
MBBS Graduate, Dubai Medical College
Safiya Hilal Alhabsy
Medical Intern Ras Al Khaimah EHS Hospitals
Eman Saeed Khouri
Sharjah Al Kuwait Hospital
Omar Hussam Abdelrahman Shamia
Intern Doctor, Ajman University, Ajman, UAE
Fatima Abdalla Alshamsi
Al Qassimi hospital, UAE
Mohammed Rahim Hossain
Sharjah Al Kuwait Hospital
Asma Muhumed Hussein
Tbilisi State Medical University, Tbilisi, Georgia
Amirah Yassin Saeed
Caucasus International University, Tbilisi, Georgia
Khadiga Abayazeed Hassan Ahmed
Sudan International University