Direct oral anticoagulants linked with higher bleeding risk in kidney disease patients

July 12, 2018, American Society of Nephrology

Certain blood thinners approved to treat atrial fibrillation may put patients with chronic kidney disease (CKD) at a higher risk of bleeding, according to the results of a study in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

Direct oral anticoagulants, which are a certain type of blood thinners used to treat , are cleared by the kidneys to varying degrees, and their elimination is slower in individuals with CKD. This may predispose these patients to drug accumulation and a greater risk of bleeding events. Although all randomized clinical trials of direct oral anticoagulants have excluded patients with severe kidney dysfunction, these medications have been approved by the US Food and Drug Administration for use in patients with advanced kidney disease.

Given that approximately one-quarter of patients with atrial have CKD, the real-world safety and effectiveness of direct oral anticoagulants in patients with atrial fibrillation across the spectrum of function is of great public health importance. To investigate, Jung-Im Shin, MD, Ph.D. (Johns Hopkins University) and her colleagues examined 2010-2017 information from the electronic health records of 3206 patients with atrial fibrillation who used direct oral anticoagulants and similar 3206 patients with atrial fibrillation who used the conventional warfarin.

There were 1181 bleeding events and 466 ischemic strokes over 7391 person-years of follow-up. (A person-year is the number of years of follow-up multiplied by the number of people in the study.) In patients without CKD, the risk of bleeding and benefits of preventing ischemic stroke between direct oral anticoagulant and warfarin use were similar. On the other hand, patients with CKD who took direct oral anticoagulants had 23% higher risk of bleeding compared with those on warfarin, but similar benefits from prevention of ischemic stroke.

"Despite sparse evidence in safety and effectiveness of direct oral anticoagulants in CKD, we saw that prescription of direct oral anticoagulants in the CKD population increased substantially over time. We also found that direct oral anticoagulant use was linked with a higher risk of bleeding compared to warfarin use in patients with CKD." said Dr. Shin.

The findings suggest the need for caution in prescribing direct oral anticoagulants in with CKD.

Study co-authors include Alex Secora, MPH, G. Caleb Alexander, MD, MS, Lesley A. Inker, MD, MS, Josef Coresh, MD, Ph.D., Alex R. Chang, MD, MS, and Morgan E. Grams, MD, Ph.D.

Explore further: New anti-clotting drugs linked to lower risk of serious bleeding

More information: Jung-Im Shin et al, Risks and Benefits of Direct Oral Anticoagulants across the Spectrum of GFR among Incident and Prevalent Patients with Atrial Fibrillation, Clinical Journal of the American Society of Nephrology (2018). DOI: 10.2215/CJN.13811217

Related Stories

New anti-clotting drugs linked to lower risk of serious bleeding

July 4, 2018
New drugs known as direct oral anticoagulants (DOACs) used to treat serious blood clots are associated with reduced risks of major bleeding compared with the older anti-clotting drug, warfarin, finds a study in The BMJ today.

For dialysis patients with AFib, a newer blood thinner may provide a safer option

June 29, 2018
People with irregular heartbeat due to a condition called atrial fibrillation, are often prescribed blood thinners to reduce the risk of blood clots that can cause a stroke. But for those who are also on dialysis for kidney ...

Some blood thinners may increase heart attack risk

March 22, 2017
A new study has examined whether different blood thinning medications prescribed to prevent strokes in patients with atrial fibrillation might increase the risk of heart attacks.

New oral anticoagulant drugs associated with lower kidney risks

November 20, 2017
Mayo Clinic researchers have shown a link between which type of oral anticoagulant (blood-thinning medication) a patient takes to prevent a stroke and increased risks of kidney function decline or failure.

Use of non-vitamin K blood-thinners with certain medications associated with increased risk of major bleeding

October 3, 2017
Among patients with nonvalvular atrial fibrillation, concurrent use of certain commonly prescribed medications with non-vitamin K oral anticoagulants was associated with an increased risk of major bleeding, according to a ...

Recommended for you

Breakthrough in designing a better Salmonella vaccine

September 24, 2018
UC Davis researchers announce in the Proceedings of the National Academy of Sciences this week a breakthrough in understanding which cells afford optimal protection against Salmonella infection—a critical step in developing ...

Antifungal agent found to be possible treatment for porphyria

September 24, 2018
A large team of researchers from Spain, France and the U.S. has found that a common antifungal agent might be useful as a treatment for a rare type of porphyria. In their paper published in the journal Science Translational ...

New findings on the muscle disease Laing early-onset distal myopathy

September 24, 2018
New avenues are now being opened toward treatment of Laing distal myopathy, a rare disorder that causes atrophy of the muscles in the feet, hands and elsewhere. In a study published in the journal PNAS, researchers have identified ...

Insulin shows great potential against chronic colitis

September 24, 2018
Diabetes is not the only disease on which insulin has an effect, it appears. In a new study using tests on mice, researchers from the University of Copenhagen, among others, have discovered a new method for treating chronic ...

A new approach to developing a vaccine against vivax malaria

September 21, 2018
A novel study reports an innovative approach for developing a vaccine against Plasmodium vivax, the most prevalent human malaria parasite outside sub-Saharan Africa. The study led by Hernando A. del Portillo and Carmen Fernandez-Becerra, ...

Pre-clinical success for a universal flu vaccine offers hope for third generation approach

September 21, 2018
Researchers from the University of Oxford's Department of Zoology have demonstrated pre-clinical success for a universal flu vaccine in a new paper published in Nature Communications.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.