Non-vitamin K oral anticoagulants may be best for early-stage CKD

(HealthDay)—Non-vitamin K oral anticoagulants (NOACs) have a superior benefit-risk profile to that of vitamin K antagonists (VKAs) for patients with early-stage chronic kidney disease (CKD), according to a review published online July 16 in the Annals of Internal Medicine.

Jeffrey T. Ha, M.B.B.S., from the University of New South Wales in Sydney, and colleagues examined the benefits and harms of VKAs and NOACs in adults with CKD stages 3 to 5. Data were included for 45 trials involving 34,082 participants who received anticoagulation for atrial fibrillation (AF; 11 trials), venous thromboembolism (VTE; 11 trials), thromboprophylaxis (six trials), prevention of dialysis access thrombosis (eight trials), and cardiovascular disease other than AF (nine trials).

The researchers found that in AF, NOACs reduced the risks for stroke or systemic embolism and hemorrhagic stroke (risk ratios, 0.79 [95 percent confidence interval, 0.66 to 0.93] and 0.48 [95 percent confidence interval, 0.30 to 0.76], respectively) compared with VKAs. The effects of NOACs on recurrent VTE or VTE-related death were uncertain compared with VKAs (risk ratio, 0.72; 95 percent confidence interval, 0.44 to 1.17). NOACs seemed to reduce major bleeding risk compared with VKAs in all trials combined (risk ratio, 0.75; 95 percent confidence interval, 0.56 to 1.01).

"NOACs had a benefit-risk profile superior to that of VKAs in patients with early-stage CKD, with significant reductions in stroke or systemic embolism and hemorrhagic stroke in AF," the authors write. "However, evidence is insufficient to recommend widespread use of VKAs or NOACs to improve clinical outcomes in patients with advanced CKD and dialysis-dependent end-stage kidney disease."

Several authors disclosed financial ties to the biopharmaceutical industry.