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Front. Physiol. | doi: 10.3389/fphys.2018.01644

A renal function based trade-off analysis of non-vitamin K antagonist oral anticoagulants in nonvalvular atrial fibrillation

  • 1Third Xiangya Hospital, Central South University, China
  • 2Memorial Health System, United States
  • 3Renji Hospital, Shanghai JiaoTong University School of Medicine, China

Background Non-vitamin K antagonist oral anticoagulants (NOACs) depend on some degree of renal excretion, and no head-to-head comparisons based on renal function is available. This study mainly investigated the trade-off property of NOACs in nonvalvular atrial fibrillation (NVAF) with varying degrees of renal function.
Methods 5 phase Ⅲ Clinical Trials comparing NOACs with warfarin in NVAF patients were included. Primary efficacy outcome was any Stroke or systemic embolism (S/SE). Major bleeding was considered as a primary safety outcome. Risk ratios (RRs) with their confidence intervals (CIs), the surface under the cumulative ranking curve (SUCRA), and trade-off analysis were conducted by renal function.
Results A total of 72961 NVAF patients were included. In terms of normal renal function, dabigatran-150mg was ranked first for efficacy (SUCRA: 90.3), and edoxaban-30mg was ranked first for safety (SUCRA: 93.3). Dabigatran-110mg/150mg, and apixaban-5mg were regarded as the most effective and reasonably safe interventions in the trade-off analysis. Regarding mild renal impairment, edoxaban-60mg was ranked first for efficacy (SUCRA: 97.8), and edoxaban-30mg was ranked first for safety (SUCRA: 99.5). Edoxaban-60mg and dabigatran-150mg were accounted as the most effective and reasonably safe interventions. With regards to moderate renal impairment, dabigatran-150mg was ranked first for efficacy (SUCRA: 95.1), and edoxaban-15mg was ranked first for safety (SUCRA: 98.2). Apixaban-2.5mg and Edoxaban-30mg was considered as the reasonably effective and the safest interventions.
Conclusions Dabigatran-150mg seems the most effective therapy in patients with normal renal function and moderate renal impairment, and edoxaban-60mg in patients with mild renal impairment. Low dose edoxaban (15mg and 30mg) seems the safest intervention. Apixaban-2.5mg and edoxaban-30mg might be the best trade-off property in moderate renal insufficiency.

Keywords: Renal function, Nonvalvular atrial fibrillation, non-vitamin K antagonist oral anticoagulants (NOACs), Trade-off analysis, cardiac arrhythmia and fibrillation

Received: 31 Aug 2018; Accepted: 31 Oct 2018.

Edited by:

Leon G. Fine, Cedars-Sinai Medical Center, United States

Reviewed by:

Yue Zhang, Nanjing Medical University, China
Hong Jiang, Zhejiang University, China  

Copyright: © 2018 Zhou, Zhang, Zhang, Shen, Gu and Zuo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Zhichun Gu, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200000, China, guzhichun213@163.com
Prof. Xiao-Cong Zuo, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, China, zuoxc08@126.com