P0706THE EFFECT OF NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS ON RENAL OUTCOMES IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

Abstract

Background and Aims: Lifelong oral anticoagulation (either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOACs)) is indicated for stroke prevention in most patients with atrial fibrillation (AF). NOACs has been recommended for thromboembolism prophylaxis of nonvalvular AF. However, studies on the impact of NOACs on renal outcomes has been inconclusive. Method: This retrospective cohort study compared 3 NOACs: apixaban, dabigatran and rivaroxaban to warfarin for their effects on renal outcomes in patients with nonvalvular AF who had been using these medications for at least 2 years as of 2017-2018. The primary outcome was either the incidence of > 30% decline in estimated glomerular filtration rate (eGFR) or doubling of the serum creatinine levels compare to baseline values at 24 months, and the secondary outcome was the incident of primary outcomes in different baseline eGFR subgroups (> 60 vs< 60 ml/min/1.73m2) and major bleeding as an adverse event. Results: 90 patients were enrolled in each group, totaling to 360 patients. The incidence of >30% decline in eGFR is significantly higher in rivaroxaban compared to warfarin (hazard ratio: 2.09; 95% confidence interval: 1.35 to 3.24; p = 0.001). After multivariate analysis (using age, stage of chronic kidney disease, eGFR, CHAD2VAS and HASBLED score), dabigatran was also shown to significantly increase the incidence of > 30% decline in eGFR. In subgroup analysis, rivaroxaban resulted in higher incidence of > 30% decline in eGFR, in eGFR < 60 ml/min/1.73m2 subgroup and higher incidence of doubling of the serum creatinine level in eGFR > 60 ml/min/1.73m2 subgroup. There was no occurrence of major bleeding. Conclusion: NOACs, especially rivaroxaban, may increase adverse renal outcomes in patients with nonvalvular AF.