Incidence of adverse clinical events during anticoagulant therapy in patients with nonvalvular atrial fibrillation associated with renal dysfunction

Abstract

Objective and methods: This study, involving patients with nonvalvular atrial fibrillation (NVAF) associated with renal dysfunction (estimated glomerular filtration rate, <60 ml/min/1.73 m²), retrospectively compared the incidence of adverse clinical events between those treated with warfarin (Wa; n = 166; age, 79 ± 8 years) and those treated with direct oral anticoagulants (DOACs; n = 196; age, 80 ± 10 years). Results: The incidence rates of ischemic stroke or systemic embolism were 3.41 and 1.75 cases per 100 person-years and those of major bleeding were 3.70 and 1.09 cases per 100 person-years in the Wa and DOAC groups, respectively. The all-cause mortality rates in the Wa and DOAC groups were 7.39 and 5.02 cases per 100 person-years, respectively. In multivariate analysis, the incidence of ischemic stroke/systemic embolism and major bleeding in the DOAC groups was significantly lower than that in the warfarin group, but no differences were noted in the all-cause mortality rate between the two groups. Conclusion: In patients with NVAF associated with renal dysfunction, the incidence of adverse clinical events in DOAC-treated patients was lower than or similar to that in warfarin-treated patients in daily clinical practice.